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Biomedical subjects

Rick Mayes

Publications and source records attributed to Rick Mayes.

7 recordsLinked to original sources
PubMed2006

The origins, development, and passage of Medicare's revolutionary prospective payment system.

This article explains the origins, development, and passage of the single most influential postwar innovation in medical financing: Medicare's prospective payment system (PPS). Inexorably rising medical inflation and deep economic deterioration forced policymakers in the late 1970s to pursue radical reform of Medicare to keep the program from insolvency. Congress and the Reagan administration eventually turned to the one alternative reimbursement system that analysts and academics had studied more than any other and had even tested with apparent success in New Jersey: prospective payment with diagnosis-related groups (DRGs). Rather than simply reimbursing hospitals whatever costs they charged to treat Medicare patients, the new model paid hospitals a predetermined, set rate based on the patient's diagnosis. The most significant change in health policy since Medicare and Medicaid's passage in 1965 went virtually unnoticed by the general public. Nevertheless, the change was nothing short of revolutionary. For the first time, the federal government gained the upper hand in its financial relationship with the hospital industry. Medicare's new prospective payment system with DRGs triggered a shift in the balance of political and economic power between the providers of medical care (hospitals and physicians) and those who paid for it--power that providers had successfully accumulated for more than half a century.

Blue Cross Blue Shield Insurance Plans↗
PubMed2005

DSM-III and the revolution in the classification of mental illness.

A revolution occurred within the psychiatric profession in the early 1980s that rapidly transformed the theory and practice of mental health in the United States. In a very short period of time, mental illnesses were transformed from broad, etiologically defined entities that were continuous with normality to symptom-based, categorical diseases. The third edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-III) was responsible for this change. The paradigm shift in mental health diagnosis in the DSM-III was neither a product of growing scientific knowledge nor of increasing medicalization. Instead, its symptom-based diagnoses reflect a growing standardization of psychiatric diagnoses. This standardization was the product of many factors, including: (1) professional politics within the mental health community, (2) increased government involvement in mental health research and policymaking, (3) mounting pressure on psychiatrists from health insurers to demonstrate the effectiveness of their practices, and (4) the necessity of pharmaceutical companies to market their products to treat specific diseases. This article endeavors to explain the origins of DSM-III, the political struggles that generated it, and its long-term consequences for clinical diagnosis and treatment of mental disorders in the United States.

Diagnostic and Statistical Manual of Mental Disord↗
PubMed2005

An analysis of the significant variation in psychostimulant use across the U.S.

OBJECTIVE: To provide a national profile of the area variation in per-capita psychostimulant consumption in the U.S. METHODS: We separated 3030 U.S. counties into two categories of 'low' and 'high' per-capita use of attention deficit hyperactivity disorder (ADHD) drugs (based on data from the Drug Enforcement Administration), and then analyzed them on the basis of their socio-demographic, economic, educational and medical characteristics. RESULTS: We found significant differences and similarities in the profile of counties in the U.S. that are above and below the national median rate of per-capita psychostimulant use (defined as g/per 100K population). Compared to counties below the median level, counties above the median level have: significantly greater population, higher per-capita income, lower unemployment rates, greater HMO penetration, more physicians per capita, a higher ratio of young-to-old physicians and a slightly higher students-to-teacher ratio. CONCLUSIONS: Our analysis of the DEA's ARCOS data shows that most of the significant variables correlated with 'higher' per-capita use of ADHD drugs serve as a proxy for county affluence. To provide a more complex, multivariate analysis of the area variation in psychostimulant use across the U.S.-which is the logical next step-requires obtaining price data to match the DEA's quantity data.

Adolescent↗
PubMed2005

Medicare and America's healthcare system in transition: from the death of managed care to the Medicare Modernization Act of 2003 and beyond.

This Article traces the transition--in Medicare, specifically, and in the American healthcare system, generally--from the aftermath of the Balanced Budget Act of 1997 to the passage of the Medicare Modernization Act of 2003. During this time, restrictive managed care died under an onslaught of resurgent cost pressures, legislative and legal attacks, and a vehement physician and consumer backlash. The subsequent reversion to more generous (and more expensive) health plans coincided with a recession in 2001 to trigger a return to rapidly escalating healthcare spending and yet another in the Nation's series of healthcare crises. Current trends suggest that future policymakers will have no choice but to confront the consequences of rapidly rising rates of healthcare spending.

Delivery of Health Care↗
PubMed2004

Medicare payment policy and the controversy over hospital cost shifting.

This article examines (i) the background and debate over cost shifting; (ii) hospitals as business institutions that often shift the financial responsibility for their costs in the form of differential pricing; and (iii) how the cost-shifting debate affects and is affected by Medicare. The aim is to gain a better understanding of how changes in reimbursement by large government health insurance programmes affect hospital behaviour. The article argues that the controversy over cost shifting is becoming an increasingly important issue for hospitals in the US and their ability (or willingness) to provide uncompensated charity care. The issue has also become very important for workers and their dependants. This is because workers have shouldered the largest portion of the dramatic growth in healthcare costs that have occurred in the US in recent years, due in large part to increased cost shifting (or 'sharing of financial responsibility') from their employers.

Cost Allocation↗
PubMedDate not supplied

Medicare payment policy: does cost shifting matter?

We examine cost shifting within the context of Medicare payment policy. We briefly review economic theory and available data and discuss the importance of cost shifting for policy. Then we present four central findings on cost shifting based on the views of former high-level policymakers. First, Medicare's early (pre-prospective) payment policy was a boon to hospitals. Second, Medicare payment policy is a "top-down" affair, driven by budgetary and special-interest politics. Third, federal policymakers may not consciously consider cost shifting, but state policymakers do. Fourth, Medicare payment policy requires constant adjustment, but we are "getting it right" most of the time.

Budgets↗