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At least 163 records · Page 9Linked to original sources
PubMed1992

Rates of avoidable hospitalization by insurance status in Massachusetts and Maryland.

OBJECTIVE: To determine whether uninsured and Medicaid patients have higher rates of avoidable hospitalizations than do insured patients. DESIGN: We used 1987 computerized hospital discharge data to select a cross-sectional sample of hospitalized patients. Population estimates from the Current Population Survey were used to estimate rates of admission, standardized for age and sex. SETTING: Nonfederal acute care hospitals in Massachusetts and Maryland. PATIENTS: All patients under 65 years of age who were uninsured, privately insured, or insured by Medicaid. Hospitalizations for obstetric and psychiatric conditions were excluded. MAIN OUTCOME MEASURES: Relative risk of admission for 12 avoidable hospital conditions (AHCs) identified by a physician panel. RESULTS: Uninsured and Medicaid patients were more likely than insured patients to be hospitalized for AHCs. Rates for uninsured patients were significantly greater than for privately insured patients in Massachusetts for 10 of 12 individual AHCs, and in Maryland for five of 12 AHCs. After adjustment for baseline utilization, the results were statistically significant for 10 of 12 AHCs in Massachusetts and seven of 12 AHCs in Maryland. For Medicaid patients, rates were significantly greater than for privately insured patients for all AHCs in each state before adjustment, and for nine of 12 and seven of 12 AHCs in each state, respectively, after adjustment for baseline utilization. CONCLUSION: Our findings suggest that patients who are uninsured or who have Medicaid coverage have higher rates of hospitalization for conditions that can often be treated out of hospital or avoided altogether. Our approach is potentially useful for routine monitoring of access and quality of care for selected groups of patients.

Adult↗
PubMed1987

Medicare program; inpatient hospital deductible and coinsurance amounts and Part A premium for the uninsured aged for 1988--HCFA. Notice.

This notice announces the inpatient hospital deductible and coinsurance amounts and the monthly hospital insurance premium for the uninsured aged for calendar year 1988 under Medicare's hospital insurance program. The Medicare statute specifies the formulae to be used to determine these amounts. The inpatient hospital deductible will be $540. The daily coinsurance amounts will be: (a) $135 for the 61st through 90th days of hospitalization; (b) $270 for lifetime reserve days; and (c) $67.50 for the 21st through 100th days of extended care services in a skilled nursing facility. The monthly Medicare hospital insurance premium for the 12 months beginning January 1, 1988 (for individuals who are not insured under the Social Security or Railroad Retirement Acts and do not otherwise meet the requirements for entitlement to Part A) is $234.

Aged↗
PubMedDate not supplied

Integrated delivery systems reposition for reform.

As policy-makers debate the ultimate design for health care reform, the pace of change in the fundamental structure for health care financing and delivery is accelerating, writes John Cochrane. State governments, employers, HMOs, insurers, hospitals, physicians and vendors are aggressively changing the way they are organized and do business. Cochrane's message to anyone involved in health care: "The revolution is now!"

Economic Competition↗
PubMed2002

The cost of angiography procedures: OHIP gets a bargain.

OBJECTIVE: To determine the costs for 1000 randomized interventional angiographic procedures. METHODS: An 9-page paper form was used to manually record the consumables, technologist time, room occupancy time and recovery room time for 80 different procedures collected over a 2-year period. The average cost for expendables per procedure was calculated for procedures that occurred 5 or more times. RESULTS: Of the 1000 procedures surveyed, there were 20 that had 10 or more occurrences, 9 that occurred 5-9 times and 51 that occurred less than 5 times, of which 32 had only a single occurrence. The total expendables used were $514,008. The total examination time was 1158 hours. The total technologist time was 2493 hours, and the total recovery room time was 1806 hours. Examples of the average cost per procedure are: cerebral angiogram (n = 249), avg. cost $441.24, and transvenous liver biopsy (n = 30), avg. cost $642.89. The coefficient of variation for procedure costs ranged from 15% to 139%. There were no correlations of technician time or procedure technical cost with the date of scan, indicating that there was no systematic increase or decrease in costs over the survey period. There were moderate correlations of the technical cost of a procedure with technologist time (Pearson r = 0.69) and the duration of a procedure (Pearson r = 0.73). The technical costs of interventional procedures were significantly underfunded; the reimbursement from the Ontario Hospital Insurance Plan was $278,446, or 54% of the actual costs. Fourteen procedures were reimbursed at below 50% of their costs. CONCLUSION: This shortfall in funding has serious consequences for the types and numbers of procedures that are possible in radiology departments. Funds must be diverted from other places to prevent serious rationing of these services.

Angiography↗
PubMed1990

Inadequacy of diagnosis related group (DRG) reimbursements for limb salvage lower extremity arterial reconstructions. Ad hoc committee of the Joint Council of the Society for Vascular Surgery and the North American Chapter of the International Society for Cardiovascular Surgery.

Prospective cost and reimbursement data were collected from 10 centers in various parts of the United States on 566 patients undergoing lower extremity arterial reconstructions for limb salvage and nonlimb salvage indications. Information for each patient was available on indication and type of procedure, length of stay, the type of hospital insurance, and hospital costs/charges. Diagnosis related group payments from each center were used to determine net gain or loss for each patient. Patients were classified as having claudication or critical ischemia (limb salvage). Reimbursements matched costs/charges for the claudication group; overall mean loss in this group was only $915 per patient. However, all centers had important losses in the limb salvage group. Reimbursements averaged 60% of costs/charges, with a mean loss of $8158 per patient and an overall loss for all 10 centers of $3,653,918. An effort to remedy this inequity is progressing via a dialogue between representatives of the Society for Vascular Surgery, the North American Chapter of the International Society for Cardiovascular Surgery, and the federal government.

Arteriosclerosis↗
PubMed1990

Should Medicare's trust fund be removed from the budget?

The recent proposal to to roll back the recent increase in the Social Security payroll tax has some health care executives worried. The Hospital Insurance Trust Fund is closely linked to the Social Security fund, and what affects one will surely affect the other. However, analysts say that the question of whether the trust funds should or should not be part of the federal budget masks a much bigger question. Are the Administration, Congress, and the American public ready to raise taxes to adequately fund Medicare?

Budgets↗
PubMed1982

Actual costs of the Social Security system over the years compared with 1935 estimates.

It is believed by many that the cost of the Social Security program currently is considerably higher than it had been estimated that it would be when the program was enacted in 1935. The analysis in this article indicates that the cost of the Old-Age and Survivors Insurance program in 1980, when expressed as a percentage of taxable payroll, was almost exactly the same as it was estimated initially to be then. Such cost, however, does not include the Disability Insurance and Hospital Insurance programs and, moreover, is estimated to increase by about 50 percent over the next 50 years, whereas the initial estimates showed no cost increases after 1980.

Costs and Cost Analysis↗