Biomedical subjects

S A Garfinkel

Publications and source records attributed to S A Garfinkel.

17 recordsLinked to original sources

PubMed2001

Providing information to help Medicare beneficiaries choose a health plan.

Many Medicare beneficiaries have limited knowledge of the Medicare program and related health insurance options. This is due in part to the complexity of the Medicare program and supplemental health insurance market. A recent congressional mandate through the Balanced Budget Act of 1997 called for broad dissemination of information to educate beneficiaries about their health plan options and to encourage informed health plan decision-making. In response, the Health Care Financing Administration (HCFA) launched the National Medicare Education Program (NMEP) to support the educational objectives of the BBA. This paper provides an overview of the components of the NMEP information campaign. We also review lessons learned from our experience in designing and testing a prototype consumer handbook that explains the different health plan options to Medicare beneficiaries. Through our discussion of the handbook, we highlight several ways to communicate information effectively about a complex publicly funded program to an older adult population.

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PubMed2001

Creating more effective health plan quality reports for consumers: lessons from a synthesis of qualitative testing.

OBJECTIVE: Social marketing techniques such as consumer testing have only recently been applied to develop effective consumer health insurance information. This article discusses lessons learned from consumer testing to create consumer plan choice materials. DATA SOURCES/STUDY SETTING: Data were collected from 268 publicly and privately insured consumers in three studies between 1994 and 1999. STUDY DESIGN: Iterative testing and revisions were conducted to design seven booklets to help Medicaid, Medicare, and employed consumers choose a health plan. DATA COLLECTION METHODS: Standardized protocols were used in 11 focus groups and 182 interviews to examine the content, comprehension, navigation, and utility of the booklets. PRINCIPAL FINDINGS: A method is suggested to help consumers narrow their plan choices by breaking down the process into smaller decisions using a set of guided worksheets. CONCLUSION: Implementing these lessons is challenging and not often done well. This article gives examples of evidence-based approaches to address cognitive barriers that designers of consumer health insurance information can adapt to their needs.

Consumer Advocacy↗

PubMed2001

Differences in the structure of CAHPS measures among the medicare fee-for-service, medicare managed care, and privately insured populations.

OBJECTIVE: To confirm in a new population, the Medicare fee-for-service population, the factor structure previously found in two Consumer Assessment of Health Plans Study (CAHPS) field-test surveys with Medicare HMO and adult privately insured populations. DATA SOURCES: Primary data were collected in the fall of 1998. Survey responses from the Medicare Fee-for-Service CAHPS survey field test were compared to results from the Medicare HMO and adult privately insured field-test studies conducted in the fall of 1996. STUDY DESIGN: Respondents for the field-test survey were a random sample of Medicare beneficiaries in five states who had opted for the original Medicare plan (fee-for-service). DATA COLLECTION: Data were collected by a mailed survey with a telephone follow-up survey to those who did not return the mailed survey. PRINCIPAL FINDINGS: A confirmatory factor analysis in two different samples of Medicare fee-for-service beneficiaries provided basic support for a previously reported three-factor structure underlying the CAHPS reports and rating items: (1) quality of provider or staff communications; (2) timely access to quality health care; and (3) quality of plan administration. An exploratory factor analysis revealed a variant three-factor structure. CONCLUSION: Because of differences in the factor structures among the different populations discussed, caution needs to be exercised in any composite development, based on factor analysis or any other basis, by which cross-population comparisons will be made. Comparisons should only be made on composites representing stable structure across all populations concerned.

Consumer Behavior↗

PubMed2001

Health plan decision making with new medicare information materials.

OBJECTIVE: To examine the effect of providing new Medicare information materials on consumers' attitudes and behavior about health plan choice. DATA SOURCE: New and experienced Medicare beneficiaries who resided in the Kansas City metropolitan statistical area during winter 1998-99 were surveyed. More than 2,000 computer-assisted telephone interviews were completed across the two beneficiary populations with a mean response rate of 60 percent. STUDY DESIGN: Medicare beneficiaries were randomly assigned to a control group or one of three treatment groups that received varying amounts and types of new Medicare information materials. One treatment group received the Health Care Financing Administrations's pilot Medicare & You 1999 handbook, a second group received the same version of the handbook and a Medicare version of the Consumer Assessment of Health Plans (CAHPS) report, and a third treatment group received the Medicare & You bulletin, an abbreviated version of the handbook. PRINCIPAL FINDINGS: Results of the study suggest that the federal government's new consumer information materials are having some influence on Medicare beneficiaries' attitudes and behaviors about health plan decision making. Experienced beneficiary treatment group members were significantly more confident with their current health plan choice than control group members, but new beneficiaries were significantly less likely to use the new materials to choose or change health plans than control group members. In general the effects on confidence and health plan switching did not vary across the different treatment materials. CONCLUSIONS: The 1999 version of the Medicare & You materials contained a message that it is not necessary to change health plans. This message appears to have decreased the likelihood of using the new materials to choose or change plans, whereas other materials to which beneficiaries are exposed may encourage plan switching. Because providing more information to beneficiaries did not result in commensurate increases in confidence levels or rate of health plan switching, factors other than the amount of information, such as how the information is presented, may be more critical than volume.

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PubMed2001

Beneficiary survey-based feedback on new Medicare informational materials.

In response to the Balanced Budget Act (BBA) of 1997, the Center for Medicare & Medicaid Services (CMS) initiated a massive information and education campaign to promote effective health plan decision-making. Early results suggest that the pilot version of the Medicare & You handbook and other new Medicare informational materials were viewed favorably overall. Despite their limitations, most beneficiaries found the information useful. The longer, more comprehensive materials were not perceived to be more useful than the shorter, less complicated version. Additional research is needed to determine which subgroups of beneficiaries may need more and, possibly less, information.

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PubMed1998

The effect of hospital volume on the in-hospital complication rate in knee replacement patients.

OBJECTIVE: To examine the effect of hospital volume on in-hospital surgical outcomes for knee replacement using six years of Medicare claims data. DATA SOURCES/STUDY SETTING: The data include inpatient claims for a 100 percent sample of Medicare patients who underwent primary knee replacement during 1985-1990. We supplemented these data with information from HCFA's denominator files, the Area Resource File, and the American Hospital Association survey files. STUDY DESIGN: We estimated the probability that a patient has an in-hospital complication in the initial hospitalization for the first primary knee replacement, using a Logit model, for three definitions of complication. The models controlled for hospital volume, other hospital characteristics, patient demographics, and patient health status. We tested for the endogeneity of hospital volume. DATA COLLECTION/EXTRACTION METHODS: A panel of two orthopaedic surgeons and two internists reviewed diagnosis codes to determine whether a complication was likely, possible, or due to anemia. After removing the few observations with bad or missing data, the final population has 295,473 observations. PRINCIPAL FINDINGS: The probability of a likely in-hospital complication declines rapidly from 53 through 107 operations per year, then levels off. Statistical tests imply that hospital volume is exogenous in this patient-level data. Complication rates increased steadily through the study period. Although obesity appeared to lower the probability of a complication, a counterintuitive result, further investigation revealed this to be an artifact of the claims data limit of listing no more than five diagnoses. Controlling for this restriction reversed the effect of obesity. CONCLUSIONS: Rather than uncontrolled expansion of knee surgery to small hospitals, decentralization to regional centers where at least about 50, and preferably about 100, operations per year are assured appears to be the optimal policy to reduce in-hospital complications.

Arthroplasty, Replacement, Knee↗

PubMed1997

Impact of Medicare SELECT on cost and utilization in 11 states.

In this article, the authors evaluate the cost and utilization effects of the SELECT implementations in 11 States. In particular they compare the before-and-after enrollment experiences of Medicare beneficiaries newly enrolled in SELECT plans with the experiences of those newly enrolled in traditional medigap plans. Using Medicare claims data for 1991 through 1994, the authors find that Medicare SELECT increased costs in five States, decreased costs in three States, and had no effect in three States. Cost increases were generally related to Part B utilization.

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PubMed1996

Medicare beneficiary counseling programs: what are they and do they work?

Medicare beneficiaries face myriad rules, conditions, and exceptions under the Medicare program. As a result, State Information, Counseling, and Assistance (ICA) programs were established or enhanced with Federal funding as part of the Omnibus Budget Reconciliation Act (OBRA) of 1990. ICA programs utilize a volunteer-based and locally-sponsored support system to deliver free and unbiased counseling on the Medicare program and related health insurance issues. This article discusses the effectiveness of the ICA model. Because the ICA programs serve as a vital link between HCFA and its beneficiaries, information about the programs' success may be useful to HCFA and other policymakers during this era of consumer information.

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

PubMed1996

Consumer information development and use.

The availability of informational materials to aid consumer health care purchasing decisions is increasing. Organizations developing and disseminating materials include public- and private-sector employers, providers, purchasing cooperatives, State agencies, counseling programs, and accreditation bodies. Based on case study interviews with 24 organizations, we learned that 10 included consumer satisfaction ratings and performance measures based on medical records. An additional four organizations developed materials with consumer satisfaction ratings exclusively. Printed materials were the most common medium used to convey information to consumers. However, other mechanisms for conveying the information were also employed. On the whole, the materials have not been rigorously evaluated. Evaluations are needed to determine if consumers find the information useful and how different individuals prefer to receive the information.

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

PubMed1995

Self-insuring employee health benefits.

Self-insurance is a popular way to fund employee health benefits, but it presents a potential barrier to state health insurance reform initiatives because self-insured health plans are able to avoid state regulation. Thus it is important to understand why employers self-insure. This study tests an explanatory model of self-insurance, using data from the 1989 Survey of Health Insurance Plans. Models predicting self-insurance are estimated for private employers and for all health plan sponsors, including public employers, unions, and trade associations. The author found a threshold for self-insuring among private employers at about 100 employees and another at about 200 workers when all health plan sponsors were considered. Plans with union members are more likely to be self-insured. Self-insurance is more likely in the presence of alcohol treatment mandates but less likely with mental health mandates.

Decision Making, Organizational↗

PubMed1995

Employment-based health insurance: implications of the sampling unit for policy analysis.

One of the least understood aspects of using employer data for the health reform debate concerns important differences between enterprise- and establishment-level surveys of employers. We demonstrate that the choice of sampling unit affects the size distribution of employees between large and small firms, as well as the estimated proportion of firms offering health insurance. Because health insurance decisions in multi-establishment enterprises generally are made for the entire enterprise rather than individual establishments, we conclude that enterprise surveys are most appropriate for collecting information on the factors affecting the decision to provide health insurance coverage. Nevertheless, an establishment-level survey may be preferred for evaluating decisions made at the state, regional, or industry level. But establishment-level surveys will underestimate the impact of an employer mandate on the unit that ultimately makes the decision to offer health insurance--the enterprise. Given the enormous human and financial stakes involved in health care reform, we urge policymakers and analysts to reflect on the strengths and limitations of alternative sampling units, and to consider the implications for interpreting survey data and formulating policy decisions.

Fee-for-Service Plans↗

PubMed1994

The relationship between employer health insurance characteristics and the provision of employee assistance programs.

Workplace drug and alcohol abuse imposes substantial costs on employers. In response, employers have implemented a variety of programs to decrease substance abuse in the workplace, including drug testing, health and wellness programs, and employee assistance programs (EAPs). This paper focuses on the relationship between enterprises' organizational and health insurance characteristics and the firms' decisions to provide EAPs. Using data from the 1989 Survey of Health Insurance Plans (SHIP), sponsored by the Health Care Financing Administration (HCFA), we estimated the prevalence of EAPs by selected organizational and health insurance characteristics for those firms that offer health insurance to their workers. In addition, we estimated logistic models of the enterprises' decisions to provide EAPs as functions of the extent of state substance abuse and mental health insurance mandates, state-level demographic variables, and organizational and health insurance characteristics. Our results suggest that state mandates and demographic variables, as well as organizational and health insurance characteristics, are important explanatory variables of enterprises' decisions to provide EAPs.

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

PubMed1988

High-cost users of medical care.

Based on data from the National Medical Care Utilization and Expenditure Survey, the 10 percent of the noninstitutionalized U.S. population that incurred the highest medical care charges was responsible for 75 percent of all incurred charges. Health status was the strongest predictor of high-cost use, followed by economic factors. Persons 65 years of age or over incurred far higher costs than younger persons and had higher out-of-pocket costs, absolutely and as a percentage of income, although they were more likely to be insured.

Adult↗

PubMed1987

Socioeconomic factors and Medicare supplemental health insurance.

This analysis was conducted to determine how personal and community characteristics affect coverage by private insurance to supplement Medicare. Data from the 1980 National Medical Care Utilization and Expenditure Survey were used. After controlling for health status, it was found that supplemental coverage was positively associated with education, income, number of self-reported chronic conditions, being white, being married, and having a regular source of care. Private coverage was negatively associated with Medicaid coverage and age. The only community characteristic associated with supplemental coverage was region. Consideration of local medical resources and economic measures did not change that.

Data Collection↗

PubMed1986

Choice of payment plan in the Medicare capitation demonstration.

This article identifies factors that influence the choice between joining an HMO and remaining with the traditional fee-for-service system among aged Medicare beneficiaries in three communities. Sources of marketing information were found to be strongly and positively related to the decision to join the HMO. Among beneficiaries who had to switch providers to join, persons who had a prior usual source of care and those who were satisfied with the amount of paperwork required to use that source of care were less likely to enroll in the HMO. Persons who did not have to switch providers to join the HMO were more likely to enroll in the prepaid program if they were satisfied with the amount of paperwork involved in using the HMO prior to the demonstration. Differences among the three communities suggest that the barrier to HMO enrollment presented by having a prior source of care who is not affiliated with the HMO may attenuate as the number of competing HMOs in the community increases, making the medical care environment more competitive. In the community with the most HMOs, persons who already had supplemental insurance were less likely to enroll than those who did not. None of the six HMOs studied experienced adverse selection, based on pre-enrollment health status.

Aged↗

PubMed1986

Health services utilization in the U.S. population by health insurance coverage.

The goal of the National Medical Care Utilization and Expenditure Survey (NMCUES) is to improve the understanding of the ways in which Americans use and pay for health care. This report is one in a series of descriptive reports based on NMCUES data. Data concerning several aspects of insurance coverage were collected from household respondents in NMCUES. These data included the kind of insurance in effect for each person (Medicare, Medicaid, private, or other) and the use of inpatient and ambulatory health services. The purpose of this report is to provide descriptive information about the distribution of insurance coverage among the U.S. population and the use of inpatient and ambulatory services by people with different kinds of insurance. The results presented are based on data collected about the civilian noninstitutionalized persons in the NMCUES national household sample. In this report, "person-year" estimates for health insurance coverage are used; that is, individuals are assigned to different categories of insurance coverage according to the proportion of the year that they were covered by each kind of insurance. Although estimates are calculated as person-years of coverage, they are expressed as persons covered for convenience. Two important subpopulations--persons under 65 years of age and persons 65 years of age or over--are addressed separately because they have different patterns of insurance coverage and because utilization is so heavily influenced by age. Persons 65 years of age or over used significantly more inpatient and ambulatory services than persons under 65 years of age did. Only those in the younger group with Medicare, who were disabled, had utilization rates very similar to those of the aged. Persons under 65 years of age are classified by six mutually exclusive insurance categories: All Medicare. Medicaid, no private health insurance. Private health insurance, no Medicaid. Medicaid and private health insurance. Other coverage only. No insurance. Persons 65 years of age or over are classified by four mutually exclusive categories: Medicare only. Medicare and Medicaid. Medicare and private or other coverage. No Medicare. These categories of insurance coverage describe the kind of organization or program that supplies the coverage. With the exception of Medicare, which is a national program, these classifications provide little information about the scope of benefits and level of payment available to people who are covered. Considerable variation exists by State within the Medicaid category and by plan or program within the private insurance and other coverage categories.(ABSTRACT TRUNCATED AT 400 WORDS)

Age Factors↗

PubMed1985

Supplemental health insurance coverage among aged Medicare beneficiaries.

The goal of the National Medical Care Utilization and Expenditure Survey (NMCUES) of 1980 was to improve the understanding of the ways in which Americans use and pay for health care. This report is one in a series of descriptive reports based on NMCUES data. Data concerning insurance coverage were collected from household respondents in NMCUES. These data included the kind of insurance in effect for each person, the services covered, and the amounts paid by each source. In addition, the administration of private insurance plans and the kinds of charges covered were identified. The purpose of this report is to provide descriptive information about supplemental insurance coverage among the aged Medicare population with special emphasis on private supplemental health insurance coverage. For this report, supplemental insurance is defined as coverage (i.e., Medicaid, private, or other) in addition to Medicare and is to be distinguished from the Supplementary Medical Insurance part of Medicare that is known as SMI or Part B of Medicare. The results presented are based on data collected about the civilian, noninstitutionalized persons in the NMCUES national household sample who at any time during the survey year of 1980: (1) were 65 years of age or over, and (2) reported having been covered by Medicare Hospital Insurance (HI), or Medicare Supplementary Medical Insurance (SMI), or both. This report uses time-adjusted estimates that assign a single individual to different categories of insurance coverage according to the proportion of the year that he or she was covered by each kind of insurance. Consequently, estimates are made for person-years of coverage although they are expressed as persons for convenience. Approximately 4 out of 5 aged Medicare beneficiaries reported having some kind of insurance coverage in addition to Medicare during 1980. Approximately 67 percent of the aged Medicare population are estimated to have had private insurance in addition to Medicare; an estimated 13 percent had Medicaid. (Both of these estimates include 2.5 percent who reported Medicaid and private insurance simultaneously.) About 21 percent of the aged Medicare beneficiaries reported that Medicare was their only source of third-party coverage. The percentage of the aged Medicare beneficiaries who reported Medicare as their only source of third-party coverage was consistently 20 percent regardless of health status. However, the distribution among insurance categories of the remaining 80 percent who reported supplemental coverage of some type varied by health status. Medicare beneficiaries who were in poor health were much more likely to have Medicaid than Medicare beneficiaries who reported being in excellent health.(ABSTRACT TRUNCATED AT 400 WORDS)

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