Health Care Financ R
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In this article, we measure the extent to which California Medicaid children in 1981 received preventive care services through either the regular or the Early and Periodic Screening, Diagnosis, and Treatment component of Medicaid. On average, 62 percent of children up to 15 years of age who were continuously enrolled for that year had no preventive care visits, with the percentage increasing with age. Forty-five percent of children under 5 had no preventive visits paid by Medicaid. Children outside of urban areas received fewer preventive care visits than did urban children.
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The introduction of Medicare's hospital prospective payment system has raised concerns about availability of and access to needed health care services after beneficiaries are discharged from the hospital. In this article, Medicare coverage of skilled nursing facility, home health agency, and inpatient hospital rehabilitation services is discussed and recent trends in the use of these services are explored. In addition, an overview is provided of two major studies currently sponsored by the Federal Government to examine availability and other issues related to post-hospital care.
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Health Care Financ R · Jan 1987
Effects of selected fee schedule options on physicians' Medicare receipts.
The Congress has indicated interest in modifying the system by which Medicare pays for physicians' services, and implementation of a Medicare fee schedule may be the most feasible change in the near term. In this article, the effects on physicians' Medicare receipts of a variety of fee schedules are simulated using 1984 Medicare claims data for a nationally representative sample of physician practices. The results show that reasonable choices concerning specialty and geographic differentials would shift payments away from surgical specialists and urban areas toward generalists (general practitioners, family practitioners, and internists) and less urban areas.
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The Medicare hospice benefit prospectively reimburses hospices based on the inpatient status of the patient, whether or not the patient is at home, and whether the patient is receiving round-the-clock nursing. Using national Hospice Study data, two case-mix adjusters based on patient functioning and living arrangement were found to be significantly related to per diem cost. These were tested by simulating their impact on hospice revenues. Increasing per diem reimbursements 35 percent for nonambulatory patients living alone only increases hospice revenues by 4 percent; hospices with sicker patients benefit the most.
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Health Care Financ R · Jan 1984
Comparative StudyPaying for physician services in state Medicaid programs.
This article presents new information on both methods and rates of payment for physician services in State Medicaid programs. A variety of indices comparing State programs with each other and with Medicare are developed and discussed. The information is important for both State policymakers considering cost-containment strategies and for those concerned with Medicaid access to physician services.