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PubMed1989

NAPPH (National Association of Private Psychiatric Hospitals) white paper on inpatient treatment for alcoholism.

Earlier this year, the National Association of Private Psychiatric Hospitals brought together a group of experts to reexamine and update the Association's position on inpatient treatment for alcoholism. The resulting white paper explains the role of the hospital in the treatment of various types and degrees of alcoholism, including alcoholism that coexists with significant psychiatric illnesses. This document is meant as a springboard to discussions both within the hospital and with those outside the hospital (insurers, employers, case managers, benefits managers) whose decisions have a critical impact on treatment options.

Alcoholism↗
PubMed1995

Legal obstacles to medical communities' full participation in managed care.

Strong physician-driven delivery systems are vital to the creation of a quality medical system for the United States. To compete with employers, insurers, hospitals, and the government, physicians must consolidate. Physicians do not generally have the necessary capital, management skills, or desire to manage large organizations, however. In addition, antitrust restrictions, antireferral statutes, insurance regulation, and malpractice liability risks are major legal obstacles that restrain physicians from consolidating. The government needs to recognize the problems that federal and state laws have created for the development of physician-driven delivery systems. The benefit to the medical system by relaxing these laws will outweigh any potential risk of loss to the public.

Antitrust Laws↗
PubMed1993

Follow-up after hospital discharge: does insurance make a difference?

As the length of hospital stays decreases, important medical problems are often deferred for follow-up after discharge. We investigated whether patients without regular physicians actually receive post-discharge care. Patients without regular physicians at the time of admission to a private nonprofit teaching hospital were surveyed by telephone one month after discharge. Forty-six percent were non-Caucasian and 53 percent had Medicaid or no insurance. Although discharge planning was documented for 97 percent of patients, only 54 percent of study participants had completed follow-up one month later and only 46 percent could identify a regular physician. Among all patients with a particular need for follow-up, Medicaid and uninsured patients were less likely to receive follow-up (p = 0.042), to identify a regular physician (p = 0.007), or to complete discharge instructions (p = 0.018). Cost of medical care was found to be a significant deterrent to obtaining follow-up for patients with Medicaid or with no insurance (p = 0.001). Expanded access to care, along with focused discharge planning, may improve completion of follow-up for Medicaid and uninsured patients.

Aftercare↗
PubMed1995

MSOs: key to PHOs and community-based health care systems.

In the '50s and '60s, as you drove through the United States, you could not help but notice the large number of mom and pop businesses--gas stations, groceries, restaurants. The same ride in the '70s and '80s is remembered because of the large number of these businesses that had closed their doors. In the '90s, this could very well begin to happen to doctor's offices and small clinics as medicine comes to look more and more like a business. This decade has already seen a shift in medicine from fee-for-service to more managed types of insurance and payment programs and the beginning of larger physician groups. Proposed health reform initiatives can only serve to accelerate these trends. Those in medicine prepared for changes will survive and perhaps even thrive. The others will wither on the vine. One of the key strategies that will enhance survival is cooperation and organization among the different players--hospitals, insurance companies, and providers. An extremely valuable tool for survival, along with the independent practice arrangement, the integrated delivery system, etc., will be the management service organization.

Community Health Planning↗
PubMed1994

Motorcycle accident injury severity, blood alcohol levels, insurance status, and hospital costs: a 4-year study in St. Petersburg, Florida.

Clinical, demographic, and financial information for 337 patients injured in motorcycle accidents who were admitted to a community hospital over a 4-year period was reviewed for injury severity, prevalence and degree of alcohol intoxication, and effects of insurance status on hospital, patient, and community costs. Ninety percent of the patients were males (average age 31 years), and 52% had some form of insurance. Of those tested at the time of admission, 36% had blood alcohol levels of > or = 100 mg%. Uninsured patients had higher blood alcohol levels (p = 0.0001), as did older patients (p = 0.01). Forty percent of patients had injury severity scores of > or = 16. Uncompensated costs to the hospital of caring for the uninsured totalled > $850,000 over the 4 years. The need to enforce existing statutes and to increase awareness through education is discussed, and statutory changes are recommended.

Accidents, Traffic↗
PubMed1978

Physician responsibility for the cost of unnecessary medical services.

Most diagnostic and therapeutic services are ordered by physicians, but physicians practicing under fee-for-service conditions have few incentives to contain the costs of medical care. Without such incentives, effective cost control through mechanisms such as Professional Standards Review Organizations have been disappointing. Several legal approaches might be used to increase physicians' responsibility for the cost of unnecessary services--expansion of tort law, implied contact, redesign of insurance mechanisms, equitable estoppel and informed consent. However, increasing physician responsibility will require uniform but flexible definitions of medical necessity, reliable means for predeterming the need for services and effective penalties or incentives. We propose a peer-review system that would incorporate the sharing of financial risk among physician, hospital, insurer and patient in the fee-for-service sector.

Costs and Cost Analysis↗
PubMed1993

Actuarial status of the Social Security and Medicare programs.

The Boards of Trustees for the two Social Security and the two Medicare Trust Funds recently released their annual reports to Congress detailing the operations of the trust funds during 1992 and their projected financial status for future years. Based on the Trustees' best estimates, the reports show: The Federal Old-Age and Survivors Insurance (OASI) Trust Fund is projected to be able to pay benefits for about 50 years. Congress will eventually need to take action to assure the long-range financial soundness of the program. The Federal Disability Insurance (DI) Trust Fund is projected to be exhausted in about 2 years. As a result, the Board urges that prompt legislative action be taken to improve the financial integrity of this trust fund by reallocating to the DI fund a larger share of the overall OASDI tax rate. The Federal Hospital Insurance (HI) Trust Fund is projected to be able to pay benefits for only about 6 years and is severely out of financial balance in the long-range. The Trustees urge the Congress to take additional actions designed to control HI program costs through specific program legislation and as a part of enacting comprehensive health care reform. The Federal Supplementary Medical Insurance (SMI) Trust Fund is financed on a year-by-year basis and is adequately financed. The Trustees urge the Congress to take additional actions designed to control SMI costs through specific program legislation and as a part of enacting comprehensive health care reform.

Actuarial Analysis↗
PubMed1984

Access to health care among aged Medicare beneficiaries.

The goal of the National Medical Care Utilization and Expenditure Survey (NMCUES) is to improve the understanding of the ways in which Americans use and pay for health care. This report is one in a series of descriptive reports based on NMCUES data. Data concerning several aspects of participants' access to health care services were collected in NMCUES. These included identification of a regular source of care, several characteristics of physical access to the regular source (transportation mode, travel time, waiting room time), insurance coverage, and the existence of medically unattended conditions. The purpose of this report is to provide descriptive information about selected aspects of access to health care among noninstitutionalized elderly people who reported being covered by Medicare. The results presented are based on data collected about noninstitutionalized people in the NMCUES national household sample who: (1) were 65 years of age and over at any time during the survey year, and (2) reported being covered by Medicare Hospital Insurance, Supplementary Medical Insurance, or both during the survey year (1980). The regular source of care for three out of four (74 percent) of the elderly Medicare beneficiaries was a physician's office (including group practice or doctor's clinic), while for 9 percent the regular source was a hospital outpatient clinic, emergency room, health center, or other provider type (referred to hereafter as "clinic"). Of the elderly Medicare beneficiaries, 10 percent reported no regular source of care, and the regular source was unknown for 7 percent. Of those with no regular source of care, 80 percent identified their seldom getting sick as an important reason for having no regular source, 24 percent identified their desire to go to different places for different health care needs, 14 percent said their usual source was no longer available, and 5 percent identified their recently moving into the area as an important reason. Nearly six out of ten (59 percent) of the elderly Medicare beneficiaries who reported that their regular source was a physician's office drove themselves there, and about four out of ten (43 percent) of those who reported that their regular source was a clinic drove themselves to the clinic. On the average, people traveled nearly 10 minutes more to a clinic than to a physician's office (29 versus 20 minutes). There was little variability in reported length of travel time among the various demographic categories--e.g., men tended to travel for the same length of time as did women, black people for the same travel time as white people.(ABSTRACT TRUNCATED AT 400 WORDS)

Aged↗
PubMed2005

[The optimal design of the interface system between the hospital & the medical insurance institution].

This paper tells you how to build a faster and more reliable interface system between the Hospital Management Information System (HMIS) in the hospital and the Medical Insurance Information System (MIIS) in the Medical Insurance Affairs Management Center (MIAMC). The data standards of the hospital and MIAMC should be integrated in order to reduce the unnecessary real-time transmission, so as to establish and perfect the operation mode in offline status,and to improve the performance of the communication servers. Thus, it would be a more efficient software interface system with a higher bandwidth between HMIS and MIIS. The working efficiency of the interface system and the accuracy of the balance data in the MIAMC are increased while the dependence on the inter-network communication is decreased with an improvement of the reliability and suitability of the interface system.

Ambulatory Care Information Systems↗
PubMed1985

Supplemental health insurance coverage among aged Medicare beneficiaries.

The goal of the National Medical Care Utilization and Expenditure Survey (NMCUES) of 1980 was to improve the understanding of the ways in which Americans use and pay for health care. This report is one in a series of descriptive reports based on NMCUES data. Data concerning insurance coverage were collected from household respondents in NMCUES. These data included the kind of insurance in effect for each person, the services covered, and the amounts paid by each source. In addition, the administration of private insurance plans and the kinds of charges covered were identified. The purpose of this report is to provide descriptive information about supplemental insurance coverage among the aged Medicare population with special emphasis on private supplemental health insurance coverage. For this report, supplemental insurance is defined as coverage (i.e., Medicaid, private, or other) in addition to Medicare and is to be distinguished from the Supplementary Medical Insurance part of Medicare that is known as SMI or Part B of Medicare. The results presented are based on data collected about the civilian, noninstitutionalized persons in the NMCUES national household sample who at any time during the survey year of 1980: (1) were 65 years of age or over, and (2) reported having been covered by Medicare Hospital Insurance (HI), or Medicare Supplementary Medical Insurance (SMI), or both. This report uses time-adjusted estimates that assign a single individual to different categories of insurance coverage according to the proportion of the year that he or she was covered by each kind of insurance. Consequently, estimates are made for person-years of coverage although they are expressed as persons for convenience. Approximately 4 out of 5 aged Medicare beneficiaries reported having some kind of insurance coverage in addition to Medicare during 1980. Approximately 67 percent of the aged Medicare population are estimated to have had private insurance in addition to Medicare; an estimated 13 percent had Medicaid. (Both of these estimates include 2.5 percent who reported Medicaid and private insurance simultaneously.) About 21 percent of the aged Medicare beneficiaries reported that Medicare was their only source of third-party coverage. The percentage of the aged Medicare beneficiaries who reported Medicare as their only source of third-party coverage was consistently 20 percent regardless of health status. However, the distribution among insurance categories of the remaining 80 percent who reported supplemental coverage of some type varied by health status. Medicare beneficiaries who were in poor health were much more likely to have Medicaid than Medicare beneficiaries who reported being in excellent health.(ABSTRACT TRUNCATED AT 400 WORDS)

Aged↗
PubMed1990

Medicare program; inpatient hospital deductible and coinsurance and skilled nursing facility coinsurance for 1990--HCFA. Notice.

This notice announces that the inpatient hospital deductible for calendar year 1990 under Medicare's hospital insurance program (part A) remains the same as announced on September 29, 1989 at 54 FR 40205. However, the repeal of the Medicare Catastrophic Coverage Act of 1988 by the Medicare Catastrophic Coverage Repeal Act of 1989 restored 1988 part A coverage and cost-sharing rules, including the benefit period provisions, coinsurance charges, and the three-day prior hospitalization requirement for skilled nursing facility (SNF) care. Because the Part A catastrophic benefits under the Medicare Catastrophic Coverage Act of 1988 were in effect in 1989, the Medicare Catastrophic Coverage Repeal Act of 1989 included several provisions that apply to beneficiaries who were inpatients of hospitals or SNFs both at the end of 1989 and the beginning of 1990.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1988

Actuarial status of the HI and SMI Trust Funds.

This article is adapted from the 1988 Annual Reports of the Medicare Board of Trustees. It presents a summary of the current financial and actuarial status of the Hospital Insurance (HI) and Supplementary Medical Insurance (SMI) Trust Funds. The Board found that the present financing schedule for the HI program is sufficient to ensure the payment of benefits over the next 17-20 years if the intermediate (II-A and II-B) assumptions underlying the estimates are realized. Although steps have been taken to reduce the rate of growth in payments to hospitals, the Board urges Congress to take remedial measures to bring future HI program costs and financing into balance. The Board found the SMI program to be actuarially sound but recommends that Congress take action to curtail the rapid growth in that part of Medicare.

Actuarial Analysis↗