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Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

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At least 505 records · Page 28Linked to original sources
PubMed1996

Evaluation of a health promotion demonstration program for the rural elderly.

OBJECTIVE: This article evaluates a demonstration program that extended coverage for disease prevention/health promotion services to Medicare beneficiaries. STUDY SETTING/DATA SOURCES: Community-dwelling Medicare beneficiaries who lived in five rural counties in northwest Pennsylvania were recruited between May and December 1989. The demonstration lasted 18 months and beneficiaries were followed for an additional 18 months. Data for the evaluation came from an initial health risk assessment, Medicare administrative records, follow-up surveys, and redeemed vouchers for the waivered services. The waivered services included health screenings, influenza immunization, nutritional counseling, smoking and alcohol cessation, and depression/dementia evaluations. STUDY DESIGN: Medicare beneficiaries were randomized to one of two experimental groups and a control group. One experimental group received the newly waived services from hospitals that received a capitated fee; the other received services from providers who were paid fee-for-service. Eligibility for most waivered services was based on risk. Chi-square tests of association were used to determine if use of health promotion services and use of medical care services varied across groups. Logistic regressions were used to assess the factors associated with participation. Product-limit survival analysis was used to assess whether mortality rates varied across groups. PRINCIPAL FINDINGS: Participation rates in the new programs varied by program and by experimental group, and ranged from 16.8 percent for smoking cessation programs to 58 percent for influenza immunization. The demonstration led to an increase in influenza immunization rates relative to the control group. There were no differences in the use of medical care services or health outcomes between the experimental and control groups. CONCLUSIONS: Older rural Americans will modestly increase their use of disease prevention/ health promotion services if they are covered by Medicare. Use will be higher among those with more education. Further research is needed to assess long-term benefits of such programs.

Activities of Daily Living↗
PubMed1998

Batten down the hatches.

Explore the source record for details and available documents.

Centers for Medicare and Medicaid Services, U.S.↗
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↗
PubMed1992

Multiple significant trauma diagnosis related groups: analysis and national projections based on the first year in an all-payor prospective payment system.

To assess the effect of diagnosis related group (DRG) changes on reimbursement for trauma care in New York State (NYS), 840 trauma patients were studied over a 2-year period. Average costs increased moderately ($10,338 vs. $11,646) while average revenues increased dramatically ($6,934 vs. $9,115), leading to a 21% reduction in operating losses ($1,310,625 vs. $1,032,733). This was largely a result of new multiple significant trauma (MST) DRGs. The impact of 1990/1991 DRG changes was assessed; a 39% reduction in operating losses occurred. Regression analysis of 1989 DRG case weight on cost indicated that MST DRGs were better predictors of resource utilization than other trauma DRGs. Review of NYS data affirmed that only 10% of trauma patients were assigned MST DRGs and 63% of trauma patients were discharged from community hospitals. On a national level, the effect of the new Medicare MST DRGs would be minimal, since only 5% of Medicare patients were assigned MST DRGs. Although improvements have been made, reimbursement for trauma care must be addressed further.

Adolescent↗
PubMed2002

Prospective per diem rates for skilled nursing care.

On July 1, 1998, Medicare's cost-related reimbursement method for skilled nursing facility care was replaced with a prospective payment system that includes a case-mix adjustment based on the Resource Utilization Groups to which Medicare residents are assigned. Shortly thereafter, Congress modified the new system in response to the industry's complaints about low payment rates. The new system aims to align Medicare payments more closely with the costs facility's incur in serving Medicare residents and slow Medicare spending growth. Recent rate increases have reduced the new system's ability to trim Medicare outlays.

Accounting↗
PubMed2001

Health plan decision making in the Medicare population: results from a national randomized experiment.

OBJECTIVE: To examine the effect of providing the Medicare & You handbook on consumers' attitudes and behavior regarding health plan decision making. DATA SOURCE: A national sample of 3,738 Medicare beneficiaries who were surveyed in late 1999 and early 2000 was employed. Data were collected using a mail survey with telephone follow-up; the response rate was 76 percent. STUDY DESIGN: Medicare beneficiaries were randomly assigned to a control group that received no Medicare-related in formation as part of the study, or to a treatment group that received a copy of the 2000 version of the Medicare & You handbook as part of a national mailing. Half of the treat men t group (the "re-mail" group) received a second copy of the handbook along wit h their mail survey instrument. PRINCIPAL FINDINGS: The control and treatment groups did not differ regarding their level of satisfaction with or confidence in their current choice of health plan according to predicted mean values. Treatment group beneficiaries had a significantly higher propensity to either change or consider changing health plans relative to beneficiaries in the control group. Controlling for other factors, 5 percent of treatment group members switched health insurance plans during the prior month compared to 3 percent of control group members. there were no significant differences in predicted values between the re-mail and no re-mail groups in any of the models. Type of supplemental insurance was also highly related to all three outcomes. CONCLUSIONS: Findings from this and a prior parallel study suggest th at messages contained in the Medicare & You handbook can have an influence on beneficiaries and the Medicare market . Thus, careful attention should be given to the wording and intent of these messages. This is particularly relevant given the current administration's emphasis on increasing enrollment in Medicare+Choice plans and findings from earlier research reporting that beneficiaries felt the handbook was pressuring them to enroll in managed care.

Aged↗