Biomedical subjects
Publications and source records attributed to R W Broyles.
The reform of the Medicare hospital reimbursement system proposed by HCFA may create incentives for hospitals to transfer costs to other payers, thus reducing the financial incentives to increase efficiency.
In this paper the individual is employed as the unit of analysis to examine the extent to which the use of physician care by beneficiaries insured under the Canadian Medicare program is determined by medical needs and sociodemographic characteristics as opposed to economic considerations. The data were derived from the Canada Health Survey, which is a stratified, multistaged sample of the entire population. The results of the discriminant and weighted multiple regression analysis indicate that the use or nonuse of service and the volume of physician care consumed is determined by medical needs and sociodemographic characteristics rather than by economic status. Accordingly, the findings of this study are consistent with the contention that the Medicare program has resulted in an equitable distribution of physician service.
This paper examines an unfavorable cost variance in an institution which employs multiple resources to provide stay specific and ancillary services to patients presenting multiple diagnoses. It partitions the difference between actual and expected costs into components that are the responsibility of an identifiable individual or group of individuals. The analysis demonstrates that the components comprising an unfavorable cost variance are attributable to factor prices, the use of real resources, the mix of patients, and the composition of care provided by the institution. In addition, the interactive effects of these factors are also identified.
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Hospitals may respond to the revenue constraints of prospective payment by altering their patient mix. This article provided a brief overview of marketing management and suggested that hospitals might change their patient mix by employing marketing strategies designed to attract patients to its services or to attract physicians who specialize in the appropriate medical disciplines.
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This article analyzes the regulatory alternative, as embodied in PL 98-21, and the competitive solution to the problem of controlling the costs of health care. It suggests that neither alternative is likely to restrain these expenditures and that both may exacerbate inequities in the distribution of health services. It also identifies a need to implement the policy option of applying the principles of prospective payment comprehensively to all patients, institutions, and "hospital related" services such as those provided by surgeons, radiologists, and anesthesiologists.
This article describes the Medicare pricing mechanism and explores potential responses to the reliance on the patient and related medical condition as the unit of payment. The analysis suggests that, although the provisions of PL 98-21 may benefit the Medicare program, the pricing system may jeopardize the financial viability of hospitals, increase inequities that emanate from differential pricing policies and, when viewed from the perspective of beneficiaries, reduce access to in-hospital care and the use of service once admitted.
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