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At least 829 records · Page 46Linked to original sources
PubMed1994

Using Medicaid claims data to evaluate a large physician fee increase.

OBJECTIVE: This study demonstrates the use of Medicaid claims data in order to evaluate a threefold fee increase in physician fees for deliveries ($265 to $795), which the Maryland Medicaid program implemented in 1986. DATA SOURCES AND STUDY SETTING: The study used Maryland Medicaid claims data for years of service 1985-1988, and was done at the Maryland Department of Health and Mental Hygiene with the help of a Robert Wood Johnson, Health Care Financing and Organization (HCFO) grant. STUDY DESIGN: Overall, our design is that of a pre-test, post-test with multiple observation points both before and after the fee increase. We measured participation in three ways, corresponding to three different units of analysis. With the county-quarter year as unit of analysis, we followed a panel of providers over 16 quarters for each county in the state to determine changes in the number of delivering providers. With the individual provider as the unit of analysis, we identified effects on their Medicaid caseload between years that may have been influenced by the fee increase. Finally, we looked at continuously enrolled Medicaid women who delivered to determine the effects of the fee increase on site and volume of prenatal care. DATA COLLECTION/EXTRACTION METHODS: Analytic files for each unit of analysis were compiled from previously extracted Medicaid claims files using standard statistical software packages. PRINCIPAL FINDINGS: Using techniques described, we were able to get an in-depth picture of overall responsiveness to the intervention. We found a moderate influence of the fee increase on overall participation, less than what we would have predicted. CONCLUSIONS: Administrative data can be used to construct efficient, yet sophisticated evaluations of major policy changes. Findings from our evaluation suggest a moderate effect of the fee increase on overall participation. However, raising fees to the level of private third party payers does not in itself guarantee equal access to private physician health care for Medicaid mothers.

Adolescent↗
PubMed1993

Committed to service.

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Blue Cross Blue Shield Insurance Plans↗
PubMed1993

Hold on to X-rays.

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Dental Records↗
PubMed1993

Dynamic aspects of prescription drug use in an elderly population.

OBJECTIVE: This study explores longitudinal patterns in outpatient prescription drug use in an elderly population. DATA SOURCES/STUDY SETTING: Enrollment records and prescription drug claims were obtained for a sample of elderly Pennsylvanians (N = 27,301) who had enrolled in the Pharmaceutical Assistance Contract for the Elderly (PACE) program at any time between July 1984 and June 1987. Study Design. The study tracks monthly prescription fill rates for sampled PACE beneficiaries from their initial enrollment month through disenrollment, death, or the end of the study (whichever occurred first). We specify two-part multivariate models to assess the effect of calendar time, length of time in the PACE program, and progression to disenrollment or death both on the probability of any prescription use and on the level of use among those who filled at least one prescription claim per month. Control variables include age, gender, race, income, residence, and marital status. DATA COLLECTION/EXTRACTION METHODS: Data were extracted from administrative files maintained by the PACE program, checked for errors, and then formatted as person-month records. PRINCIPAL FINDINGS/CONCLUSIONS: We find a strong positive relationship between drug use and the length of time persons are PACE-enrolled. Persons whose death occurs within a year have much higher prescription utilization rates than do persons whose death is at least a year away, and the differential increases as death nears. Persons who fail to renew PACE coverage use significantly fewer prescription drugs in the year prior to disenrollment. Holding age and other factors constant, we find that average levels of prescription use actually declined over the study period.

Aged↗
PubMed1995

[Longitudinal analysis of utilization of inpatient treatment based on insurance data of mandatory health insurance].

AIM: To investigate which of the routinely collected claims data from the German "Legal sickness funds" on hospital utilisation may be used, in addition to that prescribed by the legislator. DESIGN: We used claims data to study a cohort of sickness fund beneficiaries who were insured during the complete year 1992 (n = 81,309). Six utilisation parameters, using the number of cases and in hospital days overall as well as diseases specific (i.e. readmission rates, in-hospital days per person with [at least] one hospital stay) were calculated. RESULTS: There are 88 persons with (at least) one hospital stay, 116 hospital cases and a total of 1306 in-hospital days per 1000 insured persons in the study cohort. The average hospital days per person (14.8 days) are ca. 30% higher than the average length of stay (11.2 days). Hospital utilisation increases with age. Hospital stays associated with ICD-239 (neoplasms of unknown origin) resulted in a higher than average number of hospital days in total although the mean length of stay is not above the average. This is due to a high readmission rate. Hospital stays associated with elective surgical procedures have a high prevalence rate but a low readmission ratio and short length of stay. CONCLUSION: The parameters related to insured persons, cases and specifically personal parameters of hospital utilisation allow a detailed analysis of hospital care; different utilisation and user patterns can be investigated and possible determinants of utilisation can be identified. After technical transformation, routine data of the sickness funds can be used to obtain information relevant for health care planners as well as for quality management.

Adolescent↗
PubMed1996

[An analysis of insurance claims of civil responsibility in radiology. The first Italian data].

The purpose of this study is to provide information to Italian radiologists regarding claims and patient injuries in medical malpractice claims. The assurance claims of Italian radiologists over a two-year period (1994-95) were anonymously analyzed, based on pertinent data provided by the Insurance Company of the Italian Society of Medical Radiology. The incidence risk-rate of claims was 9.1 per thousand person/year. Alleged malpractice accounted for more than 85% of the claims. In nearly one-half of the cases (44.4%), the plaintiff's argument was based on a < >. The most common misdiagnosis was failure to diagnose fracture or dislocation. The second most common claim category (40.7%) were complications, most commonly occurring during interventional radiology and contrast media injection. The third claim category (14.8%) was patient's accidents occurring during the diagnostic procedure. The most frequent types of injuries experienced by patients were death (6 cases), loss of chance for survival and permanent disability. Claims were more frequent in public health services, and mostly related to emergency examinations and interventional procedures. Misdiagnoses almost exclusively involved public health radiologists. Private health care, on the other hand, had a higher rate of fatal injuries, mostly related to technical complications.

Contrast Media↗
PubMed1996

[Conversion of results of expert evaluation in disputed work disability(section 275 paragraph 1a SGB V regulation)].

A statutory insurance for persons who are unable to care for themselves and require nursing attention, has been introduced in Germany. Employers must contribute to the insurance funds, and employees are likewise compelled to pay their share. To compensate employers to some extent for these expenses they can now take recourse to expertising by the Medical Services of the statutory insurance bodies if they have any doubts about an employee's inability to work. The results of such expertising have been assessed statistically and their translation into reality has been examined. Recommendations on how to improve the expertising procedure are given in this article. Laymen's wrong ideas regarding signs for possibly unjustified claims for inability to work are corrected.

Adult↗
PubMed1997

[The occupational injury act--an improvement for persons with occupational diseases?].

The aim of the study was to find out what degree employees with occupational injuries and diseases knew about the new Act, and had received compensation in accordance with the provisions. In 1994, 6,755 questionnaires were sent to persons reported to the Labour Inspection as suffering from occupational injury or disease, 3,762 (56%) responded. The study shows that at the time of the investigation only a small minority of the persons who had been reported as having occupational injuries or diseases had received compensation. Even among those who had experienced loss of income, actual expenses, or medical disability, only one subject in four had filed a claim. A number of claims may have been rejected on unlawful grounds.

Adult↗