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Biomedical subjects

W G Manning

Publications and source records attributed to W G Manning.

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

The effects of excise taxes and regulations on cigarette smoking.

We estimate a generalized linear model to examine adult and teenage cigarette demand. Out analysis focuses on the extent to which excise taxes and regulations restricting smoking in public places affect cigarette consumption. The adult results indicate that the price elasticity of demand is unstable over time, ranging from 0.06 in 1970 to -0.23 in 1985. These estimates are lower than most found in previous studies. The teenage price elasticity does not differ statistically from the estimates for adults. Additionally, regulations restricting smoking in public places have a significant effect on both adult and teenage cigarette demand.

Adolescent↗
PubMed1990

Patient, provider and hospital characteristics associated with inappropriate hospitalization.

To determine the relation between patient and provider characteristics and inappropriate hospital use, we examined adult nonpregnancy hospitalizations from a randomized trial of health insurance conducted in six sites in the United States. Appropriateness of inpatient treatment was based on medical record review; patient characteristics on sociodemographic, economic, and health status; and provider characteristics on descriptors of physician practice and hospital facilities. Twenty-seven percent of admissions attended by physicians licensed for more than 15 years were judged inappropriate, compared to 20 percent for younger physicians. Admissions were more likely to be inappropriate if the patient was female (27 percent compared with 18 percent). Controlling for patient and provider characteristics reduces but does not eliminate the differences in the appropriateness of inpatient care across the study's six sites. Differences in available provider and patient characteristics do not account for geographic differences in inappropriate hospitalization in this study.

Cost Control↗
PubMed1990

The effects of a prepaid group practice on mental health outcomes.

Does a prepaid group practice relative to comparable fee-for-service plans lead to different mental health outcomes for its beneficiaries? To answer this question, we used data from the RAND Health Insurance Experiment. We observed no statistically significant or clinically meaningful differences in mental health outcomes for families randomly assigned to Group Health Cooperative of Puget Sound or to comparable fee-for-service insurance plans in the Seattle area. We found the same null result for overall mental health status as well as for psychological distress (e.g., anxiety and depression) and psychological well-being, and for the full population as well as the initially sick and poor, although our precision was low for the latter comparisons. Thus, the less intensive style of treatment in the prepaid group practice was not associated with noticeably worse mental health outcomes.

Adult↗
PubMed1990

Patterns of outpatient mental health care over time: some implications for estimates of demand and for benefit design.

The article examines patterns of starting and continuing outpatient mental health care as a function of time, and the implications of these patterns for estimates of the response of demand to generosity of fee-for-service insurance coverage. The data are from the RAND Health Insurance Experiment (HIE), which acquired a random sample of the nonelderly general population in six U.S. sites. People rarely had more than one episode of use of outpatient mental health services in a year. Persons who used in the prior year had high rates of continuing in treatment, while those without prior use entered treatment at a low, steady rate. Similar patterns of use by former users and nonusers were observed across insurance plans that varied widely in generosity, but the absolute probabilities of use were significantly lower in less generous plans. The probability of use of mental health services expanded significantly over time in the HIE; thus, estimates of demand in a steady state would be higher than those based on the HIE study years.

Community Mental Health Services↗
PubMed1989

The taxes of sin. Do smokers and drinkers pay their way?

We estimate the lifetime, discounted costs that smokers and drinkers impose on others through collectively financed health insurance, pensions, disability insurance, group life insurance, fires, motor-vehicle accidents, and the criminal justice system. Although nonsmokers subsidize smokers' medical care and group life insurance, smokers subsidize nonsmokers' pensions and nursing home payments. On balance, smokers probably pay their way at the current level of excise taxes on cigarettes; but one may, nonetheless, wish to raise those taxes to reduce the number of adolescent smokers. In contrast, drinkers do not pay their way: current excise taxes on alcohol cover only about half the costs imposed on others.

Alcohol Drinking↗
PubMed1989

The effects of insurance generosity on the psychological distress and psychological well-being of a general population.

Reductions in the generosity of fee-for-service insurance lower the use of general medical and mental health services, but do they lead to lower mental health status for the covered population? We addressed this question using data from the RAND Corporation Health Insurance Experiment. Families in six sites in the United States were randomly assigned to one of 14 insurance plans for three- or five-year periods. On average, there were no significant adverse effects of cost-sharing plans, relative to a free-care plan, on either psychological well-being or psychological distress, when the cost-sharing plans included full catastrophic coverage. Those with high mental health status but low income at baseline had significantly more favorable mental health outcomes on the cost-sharing plans than on the free-care plan. We cannot definitively comment on the effects of insurance generosity for the sick poor. Our findings apply in the context of mandated comprehensive mental and general health coverage for a general nonelderly, nondisabled household population.

Adult↗
PubMed1989

The external costs of a sedentary life-style.

Using data from the National Health Interview Survey and the RAND Health Insurance Experiment, we estimated the external costs (costs borne by others) of a sedentary life-style. External costs stem from additional payments received by sedentary individuals from collectively financed programs such as health insurance, sick-leave coverage, disability insurance, and group life insurance. Those with sedentary life-styles incur higher medical costs, but their life expectancy at age 20 is 10 months less so they collect less public and private pensions. The pension costs come late in life, as do some of the medical costs, and so the estimate of the external cost is sensitive to the discount rate used. At a 5 percent rate of discount, the lifetime subsidy from others to those with a sedentary life style is $1,900. Our estimate of the subsidy is also sensitive to the assumed effect of exercise on mortality. The subsidy is a rationale for public support of recreational facilities such as parks and swimming pools and employer support of programs to increase exercise.

Adult↗
PubMed1989

Adjusting capitation rates using objective health measures and prior utilization.

Several analysts have proposed adding adjusters based on health status and prior utilization to the adjusted average per capita cost formula. The authors estimate how well such adjusters predict annual medical expenditures among non-elderly adults. Both measures substantially improve on the variables currently used. If only health measures are added, 20-30 percent of the predictable variance is explained; if only prior use is added, more than 40 percent is explained; if both are added, about 60 percent is explained. The results support including some measure of use in the formula until better health measures are developed.

Actuarial Analysis↗
PubMed1989

Prepaid group practice effects on the utilization of medical services and health outcomes for children: results from a controlled trial.

A total of 693 children between the ages of 0 and 13 years were randomly assigned to either a staff model HMO or to one of several fee-for-service insurance plans in Seattle to evaluate differences in medical expenditures and health outcomes. Although the fee-for-service plans varied the amount of cost sharing (0% to 95%), all children were covered for the same medical services, for either 3 or 5 years. No differences in imputed total expenditures were observed for children assigned to the HMO or any of the fee-for-service plans. Children with cost-sharing fee-for-service plans, however, had fewer medical contacts and received fewer preventive services than those assigned to the HMO. Nonetheless, children with the cost-sharing fee-for-service plans were perceived (by their mothers) to be in better health overall than those assigned to the HMO. No significant differences regarding physiological outcomes (eg, visual acuity, hemoglobin level) were observed between the two groups. The results of this experiment neither strongly support nor indict fee-for-service or prepaid care for children.

Adolescent↗
PubMed1988

The demand for episodes of mental health services.

Observational studies of demand for mental health services showed much greater use by those with more generous insurance, but this difference may have been due to adverse selection, rather than in response to price. This paper avoids the adverse selection problem by using data from a randomized trial, the RAND Health Insurance Experiment (HIE). Participating families were randomly assigned to insurance plans that either provided free care or were a mixture of first dollar coinsurance and free care after a cap on out-of-pocket spending was reached. We estimate that separate effects of coinsurance and the cap on the demand for episodes of outpatient mental health services. We find that outpatient mental health use is more responsive to price than is outpatient medical use, but not as responsive as most observational studies have indicated. Those with no insurance coverage would spend about one-quarter as much on mental health care as they would with free care. Coinsurance reduces the number of episodes of treatment, but has only a small effect on the duration and intensity of use within episodes. Users appear to anticipate exceeding the cap, and spend at more than the free rate after they do so.

Data Collection↗
PubMed1987

Use of outpatient mental health services over time in a health maintenance organization and fee-for-service plans.

The authors compared the use of outpatient mental health services in a health maintenance organization (HMO) and fee-for-service plans over a 5-year period, using data from a randomized controlled trial. In any given year, enrollees in the HMO and a fee-for-service plan with identical benefits were equally likely to visit a mental health specialist. Over several years, the HMO enrollees were about 50% more likely ever to visit a mental health specialist; fee-for-service enrollees were more likely to receive mental health care in more than 1 study year.

Adult↗
PubMed1987

Preventive care: do we practice what we preach?

We used insurance claims from enrollees in the Rand Health Insurance Experiment to determine the amount of selected components of preventive care received by a representative sample of the non-aged population in the United States and to determine whether insurance coverage was an important determinant of that amount. Only 45 percent of infants received timely immunization for DPT and polio; 93 per cent received some well child care by 18 months of age. In the three-year experimental period, only 4 per cent of adults had a tetanus shot, 66 per cent of women aged 17-44 and 57 per cent aged 45-65 received a Pap smear, and 2 per cent of women aged 45-65 had a mammogram. Cost sharing was associated with even less preventive care: 60 per cent of children on the free plan and 49 per cent on cost sharing plans received preventive care of any type. For adults, women on the free plan received more preventive care of several kinds, and those aged 45-65 received more Pap smears than those on cost-sharing plans. Even with free care, most enrollees did not receive adequate preventive care. Thus, free care alone, while significant, is not a sufficient incentive to providing recommended levels of preventive care. The average per person insurance charge for increasing the amount of preventive care to a level consistent with that recommended would be $22 for a complete set of immunizations by age 18 months, $9 for a Pap smear every three years, and $97 for a Pap test and mammogram every three years.

Adolescent↗
PubMed1987

Health insurance and the demand for medical care: evidence from a randomized experiment.

We estimate how cost sharing, the portion of the bill the patient pays, affects the demand for medical services. The data come from a randomized experiment. A catastrophic insurance plan reduces expenditures 31 percent relative to zero out-of-pocket price. The price elasticity is approximately -0.2. We reject the hypothesis that less favorable coverage of outpatient services increases total expenditure (for example, by deterring preventive care or inducing hospitalization).

Analysis of Variance↗
PubMed1987

Cost-sharing and the use of general medical physicians for outpatient mental health care.

Many patients with emotional disorders receive their mental health care from general medical physicians. In this article, we examine differences in costs and style between mental health care delivered by mental health specialists and that provided by general medical physicians, and the sensitivity to insurance of the patient's choice of mental health care provider. We use data from a randomized trial of cost-sharing, the RAND Health Insurance Experiment. Even when all outpatient mental health care was free (up to 52 visits a year), one-half of the users of outpatient mental health services visited general medical providers only. This half accounted for only 5 percent of outpatient mental health care expenditures, because the treatment delivered by general medical providers was much less intensive than that delivered by mental health specialists. Mental health status, at enrollment, was similar for those who received their mental health care from either provider group. Despite the large difference in cost of care, the choice of provider (mental health specialist versus general medical provider) was not sensitive to the generosity of insurance.

Adult↗
PubMed1987

Comparison of use of outpatient mental health services in an HMO and fee-for-service plans. Sensitivity to definition of a visit.

Whereas previous authors have used a variety of strategies to identify use of mental health services, the sensitivity of estimates to the definition of a visit has been little studied. The authors examined the sensitivity of estimates of use of outpatient mental health services in both HMO and fee-for-service plans to the method of identifying outpatient mental health visits. The HMO and fee-for-service plans had identical benefits (i.e., free care). Data were from the Rand Health Insurance Study. Mental health visits were identified using two definitions: presence of a mental health diagnosis or procedure; and presence of a mental health procedure, diagnosis, or prescription for psychotropic medication in the absence of physical disorders requiring such medications. The major policy conclusions about lower levels of use in the HMO compared to fee-for-service plans were insensitive to the definition of a visit. Nevertheless, estimates of use of general medical providers were higher when psychotropic medications were included in the definition of a mental health visit; this sensitivity to definition was significantly greater for fee-for-service than HMO participants (P less than 0.05). Further, conclusions about the comparability of enrollment mental health status of patients treated by general medical providers in HMO and fee-for-service plans were somewhat sensitive to the definition of a visit.

Data Collection↗
PubMed1986

Inappropriate use of hospitals in a randomized trial of health insurance plans.

We examined geographic variation in the rate of inappropriate hospitalization and the effect of cost sharing on that rate. The medical records of 1132 adults hospitalized in a randomized trial of health insurance plans were reviewed by two physicians who were blinded to the patients' insurance plan. They judged 23 percent of the admissions to be inappropriate and an additional 17 percent to have been avoidable by the use of ambulatory surgery. The percentage of inappropriate admissions varied among six sites (from 10 to 35 percent), but areas with low total admission rates did not necessarily have low proportions of inappropriate admissions. In plans with cost sharing for all services, 22 percent of admissions and 34 percent of hospital days were classified as inappropriate, as compared with 24 percent of admissions and 35 percent of hospital days in the plan under which care was free to the patient (these differences were not statistically significant). Our data show that a substantial fraction of hospitalization is potentially avoidable. Because cost sharing did not selectively reduce inappropriate hospitalization, it is important to develop other mechanisms to do so.

Adult↗