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PubMedDate not supplied

Medicaid home and community-based services: national program trends.

Long-term care (LTC) policymakers face mounting pressures to expand Medicaid home and community-based services while the cost of institutional provision continues to rise and consume the bulk of Medicaid LTC spending. This paper presents the latest program trends in the three Medicaid home and community-based services programs (waivers, home health, and state-plan personal care) and reports a national survey of cost control policies used on waiver programs in 2002. The findings show slowing annual rates of participation growth on individual programs, widespread use of cost controls on waivers including waiting lists, and the persistence of large interstate variations in Medicaid's provision of these services.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed2003

Gatekeeping and children's health care costs.

In the 1990's, primary care gatekeeping became a hallmark of managed care and a major model of health care delivery. Proponents claimed that gatekeeping--requiring that primary care providers preauthorize specialty visits--could control costs and improve coordination of care. However, much of this potential has remained unrealized, and managed care organizations are beginning to loosen these restrictions. This Issue Brief adds to the growing literature on the ineffectiveness of gatekeeping in controlling costs in pediatric care. The following study focuses on privately insured children, and analyzes the impact of gatekeeping on their health care expenditures.

Child↗
PubMed1993

Comparisons among national health care systems in the European marketplace.

Most European countries have adopted either a Bismarckian system of compulsory health care insurance or a national health care system funded by taxation. For both systems, a basic level of health care is free at the point of use for all citizens. Health care has been undergoing reforms in most European countries. In the western nations, the autonomy of providers of services has increased, elements of competition and cost control have been introduced, and incentives to provide more cost-effective care have been initiated. Most central and eastern European countries have begun to return to the social insurance model for funding services. The ownership of some hospitals in these countries has been transferred to the private sector or to not-for-profit organizations. The European countries vary widely in their standards of facilities and professional staffing, and these generally reflect the prosperity of the country. During the 1980s, western countries implemented measures to limit the growth of health care expenditure, resulting in some reduction in the proportion of the gross domestic product spent on health care. Cost controls may not be as effective in the 1990s, as a result of demographic changes. More modern health care systems will likely develop in some of the central and eastern European countries, although this change will probably be slow.

Cross-Cultural Comparison↗
PubMed2001

Estimating hospital costs with a generalized Leontief function.

This paper estimates a long-run hospital cost function with multiple outputs and inputs using a panel data set from Washington State hospitals during 1988-1993. We find that with our data the generalized Leontief function is more appropriate than a translog for estimating hospital cost functions. With respect to hospital costs, we find that hospitals readily adjust the use of intermediate products. Radiology, therapies and surgery, and other inpatient days, all serve as substitutes for core inpatient days. Outpatient services are found to be complementary to core inpatient services, indicating that the growth of stand-alone outpatient clinics might increase the costs of providing healthcare services. Our analysis finds that hospitals show significant economies of scale, but there is a limited amount of evidence of scope economies. Also, there is some evidence that profit-seeking hospitals achieve some of their goals by controlling costs, and that diagnostically related groups (DRG)-based Medicare services are effective in getting hospitals to control costs.

Ambulatory Care↗
PubMed1999

PROFILE: Potential for Advanced Technology to Improve Air Quality and Human Health in Shanghai.

/ Air quality in most Asian cities is poor and getting worse. It will soon become impossible to sustain population, economic, and industrial growth without severe deterioration of the atmospheric environment. This paper addresses the city of Shanghai, the air-quality problems it faces over the next 30 years, and the potential of advanced technology to alleviate these problems. Population, energy consumption, and emission profiles are developed for the city at 0.1 degrees x 0.1 degrees resolution and extrapolated from 1990 to 2020 using sector-specific economic growth factors. Within the context of the RAINS-Asia model, eight technology scenarios are examined for their effects on ambient concentrations of sulfur dioxide and sulfate and their emission control costs. Without new control measures, it is projected that the number of people exposed to sulfur dioxide concentrations in excess of guidelines established by the World Health Organization will rise from 650,000 in 1990 to more than 14 million in 2020. It is apparent that efforts to reduce emissions are likely to have significant health benefits, measured in terms of the cost of reducing the number of people exposed to concentrations in excess of the guidelines ($10-50 annually per person protected). Focusing efforts on the control of new coal-fired power plants and industrial facilities has the greatest benefit. However, none of the scenarios examined is alone capable of arresting the increases in emissions, concentrations, and population exposure. It is concluded that combinations of stringent scenarios in several sectors will be necessary to stabilize the situation, at a potential cost of $500 million annually by the year 2020. KEY WORDS: Coal; China; Shanghai; Sulfur dioxide; Air quality; Health effects

Journal Article↗
PubMed2005

Soil-transmitted helminthiasis in Uganda: epidemiology and cost of control.

A country-wide description of the distribution of soil-transmitted helminths in Uganda is reported, based on data for 20-185 school-children from 271 schools. The overall prevalence of Ascaris lumbricoides, Trichuris trichiura and hookworm was 6.3%, 5.0% and 43.5%, respectively. The prevalence of A. lumbricoides and T. trichiura was unevenly distributed in the country with prevalence greatest in south-western Uganda whereas hookworm was generally more homogeneously distributed. Based on preliminary cost analysis of an ongoing school-based control programme, the financial delivery cost per school-child treated with albendazole is estimated to be between US dollar 0.04 and 0.08 in different districts.

Adolescent↗
PubMed2000

Controlling health care costs whilst improving population health: what are the issues and can it be done in Hong Kong?

Many countries are experiencing two related types of 'transition', one leading to Improved Population Health, but the other leading to Rising Health Care Costs. This paper will present and discuss a conceptual framework for each of these trends, which illustrate key factors that are, or may be, contributing to such outcomes. Factors contributing to improved population health include: health promotion and disease prevention; effective public health; effective housing policies. Factors contributing to Rising Health Care Costs include: demographic transition, increasing life expectancy; medical technology. Hong Kong is currently digesting the recommendations of the 'Harvard Report', which considered future options for meeting the following five reform objectives: (1) Maintaining and improving equity; (2) Improving quality and efficiency; (3) Improving financial sustainability; (4) Meeting the future needs of the population; (5) Managing overall health expenditure inflation. As can be seen, the two related transition trends of improved population health and rising health care costs are reflected in these objectives. The Harvard Report recommends a Competitive Integrated Health Care option as the most appropriate 'solution' for Hong Kong in the long run. The paper will briefly comment on this proposal.

Community Health Planning↗
PubMed2005

Medicaid: Medicaid: provider reimbursement--2005. End of Year Issue Brief.

Since Title XIX of the Social Security Act was enacted in 1965, state Medicaid programs have operated under tight budget constraints. States have recognized that reimbursement rates, whether traditional fee-for-service rates or capitation rates for managed care providers, must be sufficient in order to ensure that Medicaid programs have enough providers to deliver care. However, states have often looked to save money by lowering payments to providers who deliver health care services to Medicaid beneficiaries. This cost crunch has resulted in provider payment rates that are often substantially below market rates. State legislatures, program administrators and providers have sought to find the proper balance between adequate levels of reimbursement and cost control measures. However, dissatisfaction with low reimbursement levels has caused some providers to cease participating in the Medicaid program. This has had a detrimental affect on Medicaid recipients' access to health services. States have become aware of the problem and have tried to revise their rates to find the elusive balance between adequate reimbursement and fiscal control.

Cost Control↗
PubMed1981

Blue Cross market share, economies of scale, and cost containment effort.

This paper examines two components of the hospital insurance market structure-market share and the absolute number of enrollees in Blue Cross plans-to ascertain whether market structure affects the willingness of Blue Cross plans to use cost control measure. Empirical estimates show that larger plans are more likely to use prospective reimbursement, pre-admission testing, and concurrent review. Market share, however, has a positive effect only on concurrent review. We suggest that there are economies of scale to cost control efforts, but that high market share generally does not lead to increased cost-consciousness.

Blue Cross Blue Shield Insurance Plans↗
PubMed1993

Starting a hospital-based home health agency: Part II--Key success factors.

In Part II of a three-part series, the financial, technological and legislative issues of a hospital-based home health-agency are discussed. Beginning a home healthcare service requires intensive research to answer key environmental and operational questions--need, competition, financial projections, initial start-up costs and the impact of delayed depreciation. Assessments involving technology, staffing, legislative and regulatory issues can help project service volume, productivity and cost-control.

Cost Control↗
PubMed2005

Codon and amino acid usage in two major human pathogens of genus Bartonella--optimization between replicational-transcriptional selection, translational control and cost minimization.

Intra-genomic variation in synonymous codon and amino acid usage in two human pathogens Bartonella henselae and B. quintana has been carried out through multivariate analysis. Asymmetric mutational bias, coupled with replicational-transcriptional selection, has been identified as the prime selection force behind synonymous codon selection--a characteristic of the genus Bartonella, not exhibited by any other alpha-proteobacterial genome. Distinct codon usage patterns and low synonymous divergence values between orthologous sequences of highly expressed genes from the two Bartonella species indicate that there exists a residual intra-strand synonymous codon bias in the highly expressed genes, possibly operating at the level of translation. In the case of amino acid usage, the mean hydropathy level and aromaticity are the major sources of variation, both having nearly equal impact, while strand-specific mutational pressure and gene expressivity strongly influence the inter-strand variations. In both species under study, the highly expressed gene products tend not to contain heavy and/or aromatic residues, following the cost-minimization hypothesis in spite of their intracellular lifestyle. The codon and amino acid usage in these two human pathogens are, therefore, consequences of a complex balance between replicational-transcriptional selection, translational control, protein hydropathy and cost minimization.

Amino Acids↗