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Biomedical subjects

S Zuckerman

Publications and source records attributed to S Zuckerman.

At least 55 records · Page 3Linked to original sources
PubMed1991

Effect of injected long-acting epinephrine in addition to aerosolized albuterol in the treatment of acute asthma in children.

The additional effect, if any, of subcutaneous, long-acting epinephrine (Sus-Phrine) to aerosolized albuterol for acute pediatric asthma was studied. Over an eight-month period, patients were enrolled in a prospective, randomized, controlled trial. All patients were recruited and studied in a pediatric emergency department. Forty-three children between the ages of three and 12 years, with a mean age of 8.9 years, presenting with acute asthma were enrolled. Group 1 received Sus-Phrine, 0.005 ml per kg before albuterol aerosols, as appropriate. Group 2 only received albuterol aerosols. There was no significant difference in the extent of improvement between the two groups at either 20 minutes or two hours for clinical score, peak flow, or respiratory rate. Subcutaneous, long-acting epinephrine provides no additional benefit to a beta-2 agonist by nebulization for children with acute asthma.

Administration, Inhalation↗
PubMed1991

Has PPS increased Medicare expenditures on physicians?

We use data from 1983 and 1985 on the volume of Medicare physician services to analyze whether Medicare's Prospective Payment System (PPS), which resulted in a significant decline in hospital spending, led to a partially offsetting increase in real expenditures for physician services. We also analyze the effect of increases in assignment rates, increasing incomes of the elderly, and other factors on real expenditures during this period. Our main conclusion is that PPS has at most a small positive effect on real physician expenditures. Because people spent less time in the hospital, Medicare physician spending declined; but because of incentives to shift radiology and other services out of the hospital, some of this decline was offset. We also conclude that the sharp increase in Medicare assignment rates over this period, along with the rising incomes of the elderly during this period, contributed to the observed growth.

Aged↗
PubMed1990

A geographic index of physician practice costs.

This paper develops a geographic index of physician practice costs. A Laspeyres index is derived for each Metropolitan Statistical Area and for the non-metropolitan portion of each state. Relative prices by area are obtained for four practice inputs: physicians' own time, employee wages, office rents, and malpractice insurance. Each input price proxy is weighted by the share of physician gross revenues spent on that input. The index is useful in explaining geographic variation in physician fees. It may be used in reforming the way Medicare pays physicians.

Abstracting and Indexing↗
PubMed1990

Effects of tort reforms and other factors on medical malpractice insurance premiums.

We use state-level data on physician malpractice premiums, claims, and awards, provided by insurance companies for the years 1974 to 1986, to evaluate the effectiveness of the various tort reforms that have been legislated during the 1970s and 1980s. In addition to the tort reforms, our analysis of premiums considers insurers' anticipated losses, returns on investments, the type of insurer, and premium regulation. Our results suggest that the only reforms that significantly lower premiums are those that either impose a cap on the amount of physician liability or reduce the amount of time a plaintiff has to initiate a claim. We also find that premiums are lower when states regulate rates by requiring prior approval of premiums. In addition, it appears that the observed cyclicality in premiums is due, in part, to fluctuations in the real interest rates available to insurers as returns on investments. Unfortunately, we did not find as strong a link between the determinants of premiums, claims, and awards as might be expected.

Fees and Charges↗
PubMed1989

Profits and fiscal pressure in the prospective payment system: their impacts on hospitals.

For hospitals that were under Medicare's Prospective Payment System (PPS) for one and two years in their 1985 fiscal year, this paper examines how variation in the fiscal pressure PPS imposed affected expenditures and other aspects of behavior. The analysis shows that in hospitals' second as well as first year on PPS, hospitals under greater pressure experienced greater behavioral change. However, second year changes were far smaller than changes in the system's first year. Evidence that variation in pressure reflects factors in addition to hospitals' relative efficiency and may undermine rather than promote appropriate cost containment leads the authors to propose modifications in PPS methods.

Costs and Cost Analysis↗
PubMed1988

PPS waivers: implications for Medicare, Medicaid, and commercial insurers.

This paper compares the Medicare prospective payment system (PPS) to four all-payer rate-setting systems that operated under HCFA waiver authority. The study examines the experience of Medicare, Medicaid, and commercial insurers under the two approaches. Data from several American Hospital Association surveys and from Medicaid 2082 report forms are analyzed. The paper concludes that the all-payer waiver programs have been as successful as PPS in controlling the rate of growth in Medicare costs. In addition, Medicaid programs are more successful in controlling their outlays in all-payer rate-setting environments than when they "go alone." Finally, there is no evidence to suggest that hospitals can increase charges in response to greater financial need under either PPS or the state waivers. Nevertheless, it appears that commercial insurers are better able to compete with Blue Cross plans in all-payer rate-setting states than elsewhere.

Economics, Hospital↗
PubMed1987

How did Medicare's prospective payment system affect hospitals?

Using data from 1982 and 1984, we examined how Medicare's prospective payment system affected hospitals. The study showed that hospitals paid through the prospective payment system had significantly lower increases in Medicare costs and greater declines in Medicare use than did other hospitals. Unlike these other hospitals, for which Medicare costs approximately equaled Medicare revenues, hospitals receiving prospective payment kept Medicare costs from rising as fast as Medicare revenues, earning the profit that the prospective payment system allowed. The opportunity to earn a profit led hospitals to slow increases in Medicare costs, regardless of the level of revenue constraint. However, the more the prospective payment system constrained hospitals' revenues, the more hospitals slowed increases in Medicare costs. In the most constrained hospitals, slower increases in Medicare costs were accompanied by slower increases in total hospital spending. The least constrained hospitals slowed Medicare cost increases the least and did not show their overall spending. These hospitals nevertheless increased their profit margins the most, since the prospective payment system's federal rate paid them the highest rates relative to base-year costs. Since federal rates produced extra profits, not extra cost containment, their appropriateness is questionable. The prospective payment system should be modified to eliminate windfalls while continuing to promote cost containment.

Cost Control↗
PubMed1987

Commercial insurers and all-payer regulation. Evidence on hospitals' responses to financial need.

This study explores commercial insurers' claims about cost-shifting in the broader context of hospitals' responses to revenue needs. It relies on hospital survey data from 1980 and 1982, a period that pre-dates Medicare's Prospective Payment System (PPS) for hospitals. While we find that limited amounts of cost-shifting occur, evidence does not support the notion that it is a perfect safety valve to control financial status. In addition, all-payer rate-setting does not appear to be related to hospitals' ability to shift costs. Instead, inpatient rate controls cause hospitals to contain costs, seek greater outpatient revenues and accept lower margins. Are the financial 'stresses' associated with PPS sufficient enough to kick off renewed concerns about cost-shifting? Some aggregate data from the PPS-era indicates that lower growth in Medicare payments has not resulted in cost-shifting on a widespread basis.

Cost Allocation↗
PubMed1987

Medicaid hospital spending: effects of reimbursement and utilization control policies.

Numerous Medicaid hospital spending policies were developed following the passage of the 1981 Omnibus Budget Reconciliation Act. The impact of reimbursement and utilization control policies on Medicaid hospital spending was measured using Medicaid program data for 1977-84. Medicaid prospective reimbursement was found to contain real hospital spending by controlling spending per recipient. However, sustained reductions in the growth in real Medicaid spending are achieved only when Medicaid is included in a broader regulatory framework, not when it is the sole regulated payer. Prior authorization for specific services reduces growth in hospital spending by reducing the growth in inpatient recipients.

Acute Disease↗
PubMed1987

Rate setting and hospital cost-containment: all-payer versus partial-payer approaches.

This article explores the relative cost-containment potential of hospital rate-setting programs that differ in the extent of payer coverage. While the analysis has implications for the impact that Medicare's prospective payment system (PPS) may have on overall hospital costs, this study is based on a comparison of all-payer and partial-payer state systems in the pre-PPS era. Data on hospital costs are drawn from the 1982 and 1983 American Hospital Association's Annual Surveys of Hospitals. The data confirm that all types of mandatory rate-setting systems are effective systems of cost control. The findings suggest that all-payer approaches may have some short-run advantages in terms of reducing the growth in hospital costs but that, as of 1983, they had not attained a lower level of costs (measured on a per-admission basis) than partial-payer systems.

Cost Control↗