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Biomedical subjects

S H Long

Publications and source records attributed to S H Long.

At least 55 records · Page 3Linked to original sources
PubMed1984

Medical expenditures of terminal cancer patients during the last year of life.

To measure the patterns of medical expenditures under conventional modes of cancer care for the terminally ill, we examined Blue Cross and Blue Shield Plan claims records for care during the 12 months preceding the deaths of 1,054 nonelderly patients diagnosed as having breast, colon-rectal, or lung cancer. Expenditures averaged +21,219 for the terminal year and grew exponentially as death approached, with +6,161 (29%) being spent in the final month alone. We found very few significant differences in spending or utilization by diagnosis, age, or sex of the terminal patient, but sizable differences by state of residence and between nonmetropolitan and metropolitan area residents. Our findings represent a baseline against which experience under new hospital payment strategies and alternative delivery systems might be compared.

Aged↗
PubMed1984

Alternative Medicare financing sources.

Medicare is financed principally by taxes--some of which burden the general population and others the elderly beneficiaries. Proposals to adjust these revenue sources are evaluated for equity, efficiency, stability, and administrative costs. A package is offered to redistribute the tax burden among all groups; it may also be good health policy.

Cost Control↗
PubMed1984

Medicare and the disadvantaged elderly: objectives and outcomes.

Medicare aimed, above all, to improve access to health care services for the most disadvantaged elderly by removing distributional, attitudinal, and financial barriers. Legislative intent was based on sketchy statistical evidence of need and enriched by extensive testimony of hardship. By more precise measurements, the mature Medicare program is shown to have been largely successful. Yet, some problems of access remain, and some costly side effects are identified.

Aged↗
PubMed1983

Experimental manipulation of speaking rate for studying temporal variability in children's speech.

Children's speech timing is often more variable than adults'. In the present study, two hypotheses that have been proposed to account for this observation are considered. One claims that children do not have neuromotor control capabilities comparable to adults. The other suggests that the greater variability is a statistical consequence of children's longer segment durations. These two hypotheses were examined by having children and adults speak at both faster and slower rates than normal. Within-group comparisons across different rates and between-group comparisons for similar durational values were made from spectrographic measurements. Results indicate that both statistical and neuromotor factors seem to contribute to the greater variability commonly observed in children's speech.

Adult↗
PubMed1982

Access to medical care under Medicaid: differentials by race.

The Medicaid program was designed to help correct for the unequal access to medical care by income and race in pre-1965 America. Previous evaluations of the program have claimed that on average the eligible poor have enjoyed considerable gains in access, but that the benefits of Medicaid have not been shared equally by blacks and whites. We reexamined the evidence on differential access by race early in the program (1969) and evaluate that claim for the mature program (1976). Our evaluation is conducted within the context of multivariate models of physician and hospital utilization designed to control for a variety of socioeconomic, health status, and resource supply characteristics. While earlier evaluations overstated the extent of racial differentials in 1969, blacks who were not chronically ill had significantly lower levels of ambulatory care--both within and outside of the South. Between 1969 and 1976 all race, region, and health status groups of nonelderly Medicaid recipients experienced increases in physician visits that far outpaced those of the entire nonelderly U.S. population. By 1976 blacks clearly achieved equality with whites in Medicaid ambulatory care use. The only statistically significant shortfall we find is in hospital utilization among Southern blacks in good health.

Black or African American↗
PubMed1982

General revenue financing of Medicare: who will bear the burden?

Two recent national advisory committees on Social Security recommended major shifts in Medicare financing to preserve the financial viability of the Social Security trust funds. This paper estimates the income redistribution consequences of the two proposals, in contrast to current law, using a micro-simulation model of taxes and premiums. These estimates show that while the current Medicare financing package is mildly progressive, the new proposals would substantially increase income redistribution under the program. Two insights provided by separate estimates, for families headed by the elderly (persons age 65 or over) versus those headed by the non-elderly, are: 1) the surprisingly large Medicare tax burdens on families headed by the elderly under the current financing package of payroll taxes, general revenues, and enrollee premiums; and 2) the substantial increases in these burdens under proposed shifts toward increased general revenue financing.

Aged↗
PubMed1980

Cost sharing, supplementary insurance, and health services utilization among the Medicare elderly.

This paper investigates the extent to which private supplementary insurance and Medicaid, which vitiate the effect of Medicare cost-sharing, encourage elderly beneficiaries to seek additional medical care. A multivariate model of health services utilization is estimated with the Tobit technique, using the 1976 Health Interview Survey. We find that either private or public supplementation induces greater use of hospital and physician services, though in amounts that vary considerably according to health status. The paper closes with observations on cost savings brought about by Medicare cost-sharing and some implications for equity among beneficiaries.

Deductibles and Coinsurance↗
PubMedDate not supplied

Employer health insurance and local labor market conditions.

Theory suggests that an employer's decisions about the amount of health insurance included in the compensation package may be influenced by the practices of other employers in the market. We test the role of local market conditions on decisions of small employers to offer insurance and their dollar contribution to premiums using data from two large national surveys of employers. These employers are more likely to offer insurance and to make greater contributions in communities with tighter labor markets, less concentrated labor purchasers, greater union penetration, and a greater share of workers in big business and a small share in regulated industries. However, our data do not support the notion that marginal tax rates affect employers' offer decision or contributions.

Adult↗
PubMedDate not supplied

Prescription drugs and the elderly: issues and options.

This paper examines the elderly's need for prescription drug insurance, the extent and depth of current coverage supplementary to Medicare, the characteristics of those who have coverage and those who do not, and the problem of adverse selection in individual insurance for prescription drugs. It also discusses the issues that must be resolved in choosing the direction public policy should take if more of the elderly are to be covered and examines the advantages and disadvantages of four illustrative public policy options, ranging from small expansions of Medicaid benefits through "Medigap" regulation to Medicare coverage for all elderly.

Aged↗
PubMedDate not supplied

The uninsured 'access gap' and the cost of universal coverage.

This study estimates the effect of universal coverage on the use and cost of health services by the uninsured. Adults lacking insurance for a full year have about 60 percent as many ambulatory contacts and about 70 percent of the inpatient hospital days they would have if they were covered by insurance. This "access gap" is only slightly smaller for children. Providing universal coverage would increase ambulatory contacts and inpatient days by less than 4 percent a year. The dollar cost of these new services is estimated to be $19.9 billion--a 2 percent increase in health spending.

Adult↗
PubMedDate not supplied

Challenges of state health reform: variations in ten states.

This DataWatch reports on the key findings from the 1993 Robert Wood Johnson Foundation Family Health Insurance Survey, which interviewed more than 27,000 families in ten states. There is considerable variation among the states in insurance coverage, health status, and access to care of both adults and children. Moreover, states with higher percentages of uninsured residents also have populations with lower health status and more access problems. This clustering of problems in certain states may make health care reform even more challenging for their elected officials to accomplish.

Adult↗
PubMedDate not supplied

Pooled purchasing: who are the players?

Data from the 1997 Robert Wood Johnson Foundation Employer Health Insurance Survey provide the first national estimates of the prevalence of pooled purchasing under all major arrangements. About one-quarter of all businesses participate in a pool; smaller businesses are more likely to participate, and there is substantial geographic variation in the prevalence of pool participation. Pooling appears to have modest positive effects on the availability of employee choice among plans (especially health maintenance organizations) and on the availability of information about plan quality. On the other hand, pooling as now construed does not seem to have enhanced the accessibility or affordability of insurance to employers.

Forecasting↗
PubMedDate not supplied

Comparing employee health benefits in the public and private sectors, 1997.

Data from the 1997 Robert Wood Johnson Foundation Employer Health Insurance Survey provide new information comparing public- and private-sector employee health benefits. The federal government is ahead of other employers in adopting managed competition principles using financial incentives and consumer information to promote choosing efficient plans. Federal employees experience a $200 annual compensation gap relative to those in the private sector, but it is partly explained by advantage in purchasing power. In contrast, state and local governments make higher payments toward health insurance than private-sector employers do. Their premiums are equivalent, but they pay a greater share of the total cost.

Efficiency, Organizational↗
PubMedDate not supplied

Trends in managed care and managed competition, 1993-1997.

According to the recent literature, we are experiencing a managed care "revolution," and managed competition is increasingly being embraced by private- and public-sector policymakers. Using two large employer health insurance surveys, this paper presents new estimates that both confirm and add to our understanding of changes taking place in employment-based health plans. The dramatic shifts in enrollment from indemnity to managed care largely reflect employers' choices about the types of plans to offer. Employees are limited in the number and types of plans from which they can choose. When choice is available, it is generally not governed by managed competition principles.

Costs and Cost Analysis↗