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PubMed1997

Medicare program; inpatient hospital deductible and hospital and extended care services coinsurance amounts for 1998--HCFA. Notice.

This notice announces the inpatient hospital deductible and the hospital and extended care services coinsurance amounts for services furnished in calendar year 1998 under Medicare's hospital insurance program (Medicare Part A). The Medicare statute specifies the formulae to be used to determine these amounts. The inpatient hospital deductible will be $764. The daily coinsurance amounts will be: (a) $191 for the 61st through 90th days of hospitalization in a benefit period; (b) $382 for lifetime reserve days; and (c) $95.50 for the 21st through 100th days of extended care services in a skilled nursing facility in a benefit period.

Aged↗
PubMedDate not supplied

The Balanced Budget Act of 1997 and U.S. hospital operations.

The Balanced Budget Act (BBA) of 1997 initiated several changes to Medicare payment policy in an effort to slow the growth of hospital Medicare payments and ensure the future of the Medicare Hospital Insurance Trust Fund. Although subsequent federal legislation relaxed some original proposals, restored funds were limited and directed to specific types of hospitals. In addition, these Medicare policy changes came at a time when hospitals faced private sector payment constraints. This paper assesses the short-term effects of the BBA on operations of nonprofit hospitals in the United States and compares these effects to those observed in the early 1980s during implementation of the Medicare prospective payment system (PPS). We found that some operational changes instituted by hospitals facing financial pressures from the BBA were similar to those observed for hospitals that faced pressure from Medicare PPS, including efforts to contain Medicare cost growth, to expand outpatient service provision, and to contain hospital staffing. However, during PPS implementation hospitals experienced declining inpatient use and growing profit margins, whereas post-BBA hospitals experienced growing inpatient use and declining margins.

Budgets↗
PubMedDate not supplied

Preserving the mission.

Teaching hospitals and medical schools are changing with the times, but the authors argue that other players in the delivery system--government, insurers, hospitals, and health systems--must share in the effort to preserve the nation's medical education and research infrastructure.

Academic Medical Centers↗
PubMed1978

Private health insurance plans in 1976: an evaluation.

Private health insures collected a record $39.4 billion in premiums and returned $35 billion in benefits to their subscribers in 1976--a reflection of the steadily rising cost of health care, higher utilization, and the demand for expanded services. The industry experienced a net underwriting loss of $611 million, mainly because claims and operating expenses under insurance-company group business ran 3 percent above premium income. About 77 percent of the civilian population had some form of private hospital insurance, and about the same percentage had some form of surgical insurance. Lesser proportions were covered for other types of care. An estimated 12--13 percent of the population under age 65 had no economic protection against the costs of illness or health-related care--under either a private insurance plan or public program. Although virtually all of the aged were covered by Medicare, some 13--15 million bought private insurance, most of it under plans that covered some or all of the gaps in the Federal program.

Age Factors↗
PubMed1976

The social control of organizations in the health care area.

Available data suggest that the influence and autonomy of health care professionals have been declining. Of course, professional impact remains higher in health care than perhaps any other economic sphere, but the locus of much health care decision making has been shifting from independent professionals to employed personnel of large-scale government, hospital, insurance, and research organizations. The question therefore arises as to what shall replace this previous reliance upon individual professional ethics to assure the society that its newly powerful health care organizations are functioning in a desirable manner. In other words, what are to be the preferred mechanisms for socially controlling health care organizations. This paper traces three dominant belief patterns about how the characteristics of health care organizations and their environments produce desired control. It proposes that belief patterns have emphasized (1) the non-profit motives of many health care organizations; (2) the system of interrelationships that surround health care organizations; and (3) the vast differences among health care consumers. Choices from among these models continue to depend less upon knowledge of organizational functioning than upon political dispositions and social fancy.

Blue Cross Blue Shield Insurance Plans↗
PubMedDate not supplied

Competing to death: California's high-risk system.

Competition in California has cost lives and money. Shifting care out of hospitals reduced hospital spending relative to other states, but overall health spending per capita rose to the second highest in the nation in 1990. High spending coexists with low rates of coverage--the state ranks seventh in percentage of people lacking insurance. Hospitals have closed emergency rooms and other unprofitable services while marketing duplicative and often unnecessary services to the well-insured. With real free markets unattainable in health care, California's competitive rhetoric has rationalized growing inequalities and higher costs. The market's invisible hand has picked Californians' pockets and endangered both rich and poor.

California↗
PubMed2005

Effects of race, insurance status, and hospital volume on perforated appendicitis in children.

OBJECTIVE: Previous research suggests that perforated appendicitis is more common in Medicaid patients, but the roles of minority race and hospital volume remain largely unstudied. We sought to investigate the association of perforated appendicitis in children with minority race, insurance status, and hospital volume. METHODS: We conducted a retrospective, population-based cohort study of 33184 children who had an International Classification of Diseases, Ninth Revision diagnosis code for acute appendicitis in The Kids' Inpatient Database, a pediatric database from 22 states in 1997. A multivariate logistic regression model was developed to determine patient and hospital characteristics predictive of perforated appendicitis. RESULTS: Of 33184 children with acute appendicitis, 10777 (32.5%) were perforated. In multivariate analysis, black (odds ratio [OR]: 1.24; 95% confidence interval [CI]: 1.10-1.39) and Hispanic (OR: 1.19; 95% CI: 1.10-1.29) children were more likely to have perforated appendicitis than white children. Perforation was also more likely in Medicaid patients (OR: 1.30; 95% CI 1.22-1.39) compared with privately insured children. Annual hospital volume of cases of appendicitis was not significantly associated with perforation in multivariate analysis. CONCLUSIONS: Perforated appendicitis disproportionately affected both children of minority race and children insured by Medicaid. No effect of hospital volume was observed. To reduce this racial disparity, efforts should focus on the causes of delayed diagnosis and the treatment of appendicitis in children of minority race.

Acute Disease↗
PubMed2003

Improving the quality of care for patients with pneumonia in very small hospitals.

BACKGROUND: Despite the publication of guidelines for the management of pneumonia, significant variation in care continues to exist. While there have been several published reports of quality improvement projects for pneumonia, there are few data on the effectiveness of these efforts in small hospitals. The purpose of this study was to demonstrate that a project implemented by a quality improvement organization in small hospitals would lead to an improvement in care that could not be accounted for by secular trends in the management of pneumonia. METHODS: Medicare-insured hospital admissions for pneumonia were reviewed from 20 small hospitals in Oklahoma (intervention group) at baseline and after feedback. Project intervention included onsite feedback presentations to the medical staff, samples of performance improvement materials, and comparative measures of performance of predefined quality indicators. A second group of 16 demographically similar hospitals (control group) was selected for review during the same 2 periods. These hospitals subsequently underwent an identical intervention with a follow-up assessment. RESULTS: Statistically significant improvements in process measures were demonstrated in the intervention hospitals, including performance of a sputum (P<.01) and blood (P<.001) cultures, antibiotic administration within 4 hours of hospital admission (P<.001), and administration of the first dose of antibiotic in the emergency department (P<.001). These measures in the control hospitals did not change significantly (P =.93, .08, .79, and .52, respectively) during the 2 periods. CONCLUSIONS: Improvements in processes of care achieved by the intervention hospitals resulted from activities initiated because of participation in a quality improvement organization-directed project. This study demonstrated the effectiveness of quality improvement activities in very small hospitals.

Adult↗
PubMed1984

Actuarial status of the HI and SMI Trust Funds.

This article is adapted from a summary of the 1984 annual reports of the Medicare Board of Trustees. It presents the actuarial status of the Hospital Insurance (HI) and the Supplementary Medical Insurance (SMI) Trust Funds. Although the Social Security Amendments of 1983 have made the HI program potentially less vulnerable to excessive rates of growth in the hospital industry by providing the Secretary of Health and Human Services some discretion over the level of payments to hospitals, the Board found the financing schedule for the HI program barely adequate to ensure the payment of benefits through the end of this decade if the assumptions underlying the estimates are realized. The Board found the SMI program to be financially sound, but it noted with concern the rapid growth in the cost of the program and the extent to which general revenues have become SMI's major source of financing. For both HI and SMI, the Board recommends that Congress consider ways to curtail the rapid growth in program costs.

Actuarial Analysis↗
PubMed2005

Distributional impact of recent changes in private health insurance policies.

The impacts of changes to private health insurance (PHI) policies introduced since 1999 - in particular the 30% PHI rebate and the Lifetime Health Cover - have been much debated. We present historical analyses of the impacts in terms of the proportion of Australians having hospital insurance cover under different PHI policies, by age, gender and socioeconomic status, and project these to 2010 using a new Private Health Insurance coverage model. The combined effect of the 30% rebate and Lifetime Health Cover was to increase PHI membership from just over 30% in 1998 to just under 50% by the end of 2000, due mainly to more people taking out PHI cover from among the richest 20% of the population. Among the poorest 40% the impact was minimal. Model projections suggested that, had the new PHI policies not been introduced, then the proportion of Australians with PHI would have declined to around 20% by 2010, compared with 40% if the current arrangements remained in place. Also, analysis of 2001 survey data regarding choices to use a public or a private hospital indicated that higher income groups with or without PHI were the more likely to have used a private hospital than lower income groups. Among those with PHI, older people were more likely to have used a private hospital than younger ones.

Adolescent↗
PubMed1985

Actuarial status of the HI and SMI Trust Funds.

This article is adapted from the Summary of the 1985 Annual REPORTS of the Medicare Board of Trustees. It presents the actuarial status of the Hospital Insurance (HI) and the Supplementary Medical Insurance (SMI) Trust Funds. Two actions favorably affecting the financial status of the HI Trust Fund have occurred since the publication of the 1984 REPORTS: (1) Fiscal year 1986 hospital payment rates will continue at the same level as in fiscal year 1985, and (2) the level of the annual increase in the rates that can be granted without specific justification has been reduced. Despite these two actions, the Board found that the present financing schedule is barely sufficient to ensure payment of benefits through the late 1990's if the assumptions underlying the estimates are realized. The Board found the SMI program to be financially sound, but it noted with concern the rapid growth in the cost of the program. For both HI and SMI, the Board recommends that Congress consider ways to curtail the rapid growth in program costs.

Actuarial Analysis↗
PubMed1988

Description of case-mix adjusters by the Severity of Illness Working Group of the Society of Hospital Epidemiologists of America (SHEA).

Hospitals, insurance companies, and federal and state governments are increasingly concerned about reducing patient cost expenditures while maintaining high quality patient care. One method of reducing expenditures has been to tie hospital reimbursement with a prospective payment system based on diagnosis-related groups (DRGs). However, reimbursement under the DRG system is not acceptable for all patients in all hospitals because it is neither an accurate predictor of costs nor of clinical outcome. This deficiency poses significant problems for hospitals because DRGs are used nationwide as the prospective payment system for inpatients covered by Medicare. Several case-mix adjusters have been proposed to modify DRGs to improve their accuracy in predicting costs and outcome. We reviewed five of the most widely available indices: Acute Physiologic and Chronic Health Evaluation (APACHE II), Coded Disease Staging, Computerized Severity Index (CSI), Medical Illness Severity Group System (MEDISGROUPS), and Patient Management Categories (PMC). Recommendations for the use of a single case-mix adjuster cannot be made at this time because all indices have not been compared in sufficiently diverse settings and because some are better predictors of costs while others are better predictors of clinical outcome. Hospital epidemiologists and other infection control practitioners should be informed about these indices and their potential applications as they expand their role beyond infection control problems to issues concerning cost containment, quality assurance, and reimbursement.

Cost Control↗
PubMed1982

[The new Spinal Cord Injuries Centre of the Hamburg Industrial Injuries Insurance Institutes Accident Hospital--report on its 1st year].

The former Spinal Cord Injuries Department within the Hamburg Accident Hospital of the Industrial Injuries Insurance Institutes has been expanded from 33 to 100 beds. 60 beds started operation on Febr. 1, 1981, another 20 on Aug. 1, 1981 and the remaining 20 beds on Jan. 1, 1982. The present report is based on admissions during the first twelve months of the Centre's operation, i.e. 136 recent cases and 98 re-admissions, 92% of which had come from Northern Germany. 35% of the recent cases had been admitted during the first 48 hours post-onset. 39% of the patients were tetraplegics, 57% had complete paralysis, 13% non-traumatic affections. 60% of the patients had associated injuries. 60% were covered by statutory sickness insurance. The average length of stay was 113 days for tetraplegic, and 112 days for paraplegic patients. In 60% the extent of paralysis remained unchanged. Of 10 deaths, three were due to pulmonary embolism. Decubitus ulcers had been the indication for re-admission in 36%, of whom only 20% were tetraplegics. Average stay for decubitus ulcers was three times as long as in other re-admission causes. The services rendered by the various professional departments as well as by medical consultants are reported in tabular form. The expansion responded to an urgent need, and has, among others, contributed to easing many avoidable social problems (such as long distances from home).

Adolescent↗
PubMed1996

Alcohol consumption and community hospital admissions in the United States: a dynamic regression analysis, 1950-1992.

The annual time-series analysis examines the impact of changes in per capita alcohol consumption (NIAAA,AEDS) on changes in community hospital admission rates (AHA) in the United States from 1950 to 1992 (n = 43). Increases in per capita alcohol consumption were expected to increase hospital admission rates contemporaneously and several years thereafter following an exponential risk function. Distributed lag models based on differenced data controlling for changes in: (1) per capita cigarette consumption; (2) private hospital insurance coverage; (3) the drinking age population; (4) per capita disposable personal income; and (5) health care regulatory interventions show a contemporaneous effect of per capita alcohol consumption on hospital admission rates. The time-series analyses imply that between 22-26% of US community hospital admissions are alcohol related. A comparable analysis indicates that per capita alcohol and tobacco expenditures contribute to approximately 28% of US community hospital admissions. The absence of statistically significant lagged effects is inconsistent with an exponentially declining risk functions. However, the contemporaneous effects of per capita alcohol and tobacco consumption suggest that a reduction in smoking and drinking will produce quick reductions in morbidity and hospitalizations.

Alcohol Drinking↗