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Biomedical subjects

S S Wallack

Publications and source records attributed to S S Wallack.

At least 37 records · Page 2Linked to original sources
PubMed1989

Preferred provider organizations: options for Medicare.

Preferred Provider Organizations (PPOs) offer purchasers of care several benefits, including expenditure reduction, utilization control, improved quality of care, and efficient management. Although Medicare could benefit from these outcomes, the program lags behind the private sector in PPO development. The Health Care Financing Administration (HCFA) must address several policy issues and constraints as it develops PPOs for Medicare beneficiaries. The agency must identify services and providers to include in the PPO, develop program sponsorship and administration methods, create viable provider and beneficiary incentives to participate, identify sources of PPO cost savings, and examine the role of medigap insurance policies in PPO development. In this article we discuss three possible PPO models for Medicare: a service or population specific PPO, an integrated PPO/medigap policy, and a Medicare Part A/B PPO. We conclude by identifying several issues that require further research before these PPO models can be tested.

Cost Control↗
PubMed1988

The costs of long-term care: distribution and responsibility.

Long-term care costs will result in financial hardship for millions of elderly Americans and their families. The growing number of elderly people has focused public attention on the catastrophic problem of coverage for long-term care. Social insurance is unlikely to emerge as a solution in the USA. One reason is that the expected total cost is viewed as an unmanageable burden by both Federal and State governments. To others, it is the uncertainty surrounding the projected costs. This paper reports on the results of a double-decrement life-table analysis, based on a national survey of the elderly taken in early 1977 and one year later, that estimated the distribution and total lifetime nursing-home costs of the elderly. Combining the probability of nursing-home entry and length of stay, a 65-year-old faces a 43% chance of entering a nursing home and spending about +11,000 (1980 dollars). The distribution of lifetime costs is however very skewed with 13% of the elderly consuming 90% of the resources. Thus, while the costs of nursing-home care can be catastrophic for an individual, spread across a group they are not unmanageable. Given the distribution of income and assets among the elderly, a sizeable proportion could readily afford the necessary premiums of different emerging insurance and delivery programmes. Alternative private and public models of long-term care must be evaluated in terms of the goals of a finance and delivery system for long-term care.

Actuarial Analysis↗
PubMed1988

The risk factors of nursing home entry among residents of six continuing care retirement communities.

We identified client characteristics related to nursing home entry for 3,316 residents of six continuing care retirement communities with a longitudinal dataset that follows an initially healthy entry cohort for up to 15 years. The Cox Proportional Hazards Model was used for the analysis of survival data that includes censored data. We calculated hazard indices for residents with different characteristics to show the independent effect of these variables on the probability of nursing home entry. Seven variables emerged as statistically significant covariates: sex, marital status, roommate status, entry year into the community, entry age into the community, number of hospitalizations, and community of residence. The community of residence, which in large part reflects system effects on nursing home entry, was found to be the single most important variable explaining variance in the data. Tobit analysis was used to examine the factors associated with multiple nursing home entries and total days per year spent in a nursing home. With a few exceptions, most of the variables listed above were also significant correlates of multiple entries and total days per year spent in a nursing home.

Age Factors↗
PubMed1988

Recent trends in financing long-term care.

There has been dramatic change in the financing of long-term care in the last few years. Major private insurance carriers have introduced long-term care insurance policies to meet some of the custodial care needs of a variety of consumer groups, including old and young retirees as well as current employees. Newer policies are tying coverages more closely to a measure of disability that reflect the ability of persons to live independently. Insurers, consumer groups, and policymakers have come to understand the importance of developing innovative financing mechanisms that emphasize prefunding and cash accumulation to make policies more affordable and more desirable to a broader spectrum of the aged and nonaged population.

Industry↗
PubMed1987

Life Care at Home: a new model for financing and delivering long-term care.

In this paper we describe the Life Care at Home (LCAH) concept, a new long-term care insurance and service delivery model that combines the financial and health security of a continuing care retirement community (CCRC) with the freedom and independence of living at home. LCAH retains risk pooling for long-term care and provides other benefits and guarantees of CCRCs, including unlimited nursing home care. Because subscribers live in their own homes as long as they can, LCAH costs are substantially lower than those of CCRCs and more individuals can participate. Our market research indicates that LCAH has strong appeal among the elderly. We suggest that LCAH has a market potential of 10% to 25% of all elderly.

Aged↗
PubMed1987

New directions in life care: an industry in transition.

Current approaches to financing long-term care are inadequate; they are even less likely to meet future needs of increasing numbers of disabled and chronically ill elderly persons. While insurers, providers, and policy makers are developing models of risk-pooling that cover long-term care, the industry that first put these concepts into practice is moving in other directions. Despite the success of many continuing-care retirement communities in offering full and affordable long-term care coverage, a new trend emphasizes amenities over comprehensiveness. Sponsorship and consumer demand are contrasted with insurability of risks as key issues for the industry and for policy makers.

Aged↗
PubMed1986

Client-related risk factors of nursing home entry among elderly adults.

We estimated the relative importance of various client characteristics related to nursing home entry for a national probability sample of Medicare recipients and developed predictive models of nursing home entry that account for the interactive effects among variables. In contrast with previous research, we focused on the characteristics of nursing home entrants, not residents. By using a national sample we ensured that the influence of regional variations in the configuration of long-term care services would not confound estimates of the relative effect of client-related factors. Nine variables emerged as statistically significant predictors: age, being confined to a bed, requiring help to get around, requiring aid getting around, being widowed, never married, welfare as a payment source, insurance as a payment source, and perceived health status. When these factors were controlled for, sex, geographic region, and educational status were not statistically significant.

Activities of Daily Living↗
PubMed1986

The lifetime risks and costs of nursing home use among the elderly.

In this paper, we estimate the risk of an individual of entering a nursing home throughout the aging process. We then estimate the expected lifetime costs of nursing home use both for an individual and for society as a whole. The model is based on double-decrement life-table analysis. Data are taken from a 1977 survey of 4,400 Medicare beneficiaries. At age 65, the upper bound for the lifetime risk of entering a nursing home is 43.1%. The risk of entering a nursing home increases with age until around age 80. At about age 85, the risk begins to decline significantly. At almost all ages, the lifetime risk of entry for females is twice that of males. The expected lifetime costs of nursing home care across all ages are between $10,500 and $13,600. These costs are distributed very unequally. Only 13% of the elderly account for 90% of all nursing home expenditures. Given current life expectancy, the expected annual cost per person over age 65 is between $532 and $760. In the year 2000, the expected annual average costs of nursing home care per elderly person will range from $450 to $650. The decline in the average annual cost per person reflects shifts in the age structure and increased life expectancy. These figures need not represent an unmanageable burden on society's resources. Figures presented here help establish the feasibility and desirability of long-term care risk-sharing arrangements among the elderly, like long-term care insurance, life care communities, and other models.

Actuarial Analysis↗
PubMed1986

Pricing strategies for capitated delivery systems.

This article discusses alternative methods for establishing a fairer pricing mechanism for Medicare recipients who enroll in health maintenance organizations and other competitive medical plans. The current method, based upon the adjusted average per capita cost, is inadequate because it fails to adjust premium levels for differences in health status; it establishes undesirable incentives that may lead to underservice, and it is tied to costs in the fee-for-service system. Alternative methods would incorporate health status, have Medicare share the risk with HMO's, and base payment on HMO experience.

Aged↗
PubMed1982

The University Health Policy Consortium's Center for Health Policy Analysis and Research.

In 1978, the University Health Policy Consortium, composed of Boston University, Brandeis University and the Massachusetts Institute of Technology, established the Center for Health Policy Analysis and Research for the purpose of conducting relevant policy analyses and short-term research projects for the Health Care Financing Administration. The center has completed more than fifty analytical works since its inception and concentrates its research in three major health care areas: the financing and organization of long-term care, medical care quality, and acute care financing. The flexibility of the Center's organizational structure allows the staff of the three cooperating universities to pursue new topics while maintaining an interdisciplinary approach to emerging public policy problems.

Health Policy↗
PubMedDate not supplied

Growth in prescription drug spending among insured elders.

We examine growth in prescription drug use and spending in a well-insured elderly population in 1997 and 2000. We describe the high-cost segment of this population, identifying how it differs from the rest of the elderly regarding use and types of medications, and how stable this group is over time. Drug spending by the insured elderly rose more than 18 percent annually between 1997 and 2000. High-cost elders use more brand-name drugs, treat more conditions, and use more medications per condition. Once an insured elder becomes a high-cost user of prescription drugs, that person is likely to remain so. Our study suggests that a growing population of elderly is using many medications and may require considerable drug management.

Age Factors↗