Inquiry J Health Car
-
Inquiry J Health Car · Apr 2005
State payment limitations on Medicare cost-sharing: impact on dually eligible beneficiaries.
The Balanced Budget Act (BBA) of 1997 allowed states to limit how much their Medicaid programs contributed toward the Medicare cost-sharing liability of dually eligible beneficiaries. Policymakers have grown concerned that such limitations may affect access to care for these beneficiaries. We used a quasi-experimental design to analyze changes in access from 1996 to 1998, using Medicare and Medicaid data from nine states. Cost-sharing payments fell in six of the nine states following the BBA, and access to outpatient physician visits for dually eligible beneficiaries was reduced relative to non-dually eligible beneficiaries in those states.
-
Inquiry J Health Car · Jan 2004
Telephone service interruption weighting adjustments for state health insurance surveys.
Many states rely on telephone surveys to produce estimates of uninsurance. To the extent that people in households without telephones differ from those living in households with telephones, estimates will be biased due to lack of coverage of those in households without telephones. We find the disparity in estimates of uninsurance in the Current Population Survey (all people vs. those living in households without telephones) shows a similar association to the disparity found in the state surveys (all people vs. those living in households with telephone service interruptions). We adjust the state survey weights of those people living in households that experienced telephone interruptions to account for people living in households without telephones and evaluate whether the weighting adjustment for telephone service interruptions is advisable.
-
Inquiry J Health Car · Mar 2003
Comparative StudyOwnership and changes in hospital inefficiency, 1986-1991.
This study examines how ownership affected changes in hospital inefficiency after the introduction of prospective payment by Medicare. Using a national data set, we estimate cost frontiers for 1986 and 1991 to assess hospitals' efficiency relative to best practice in both those years. ⋯ The results indicate that, in both 1986 and 1991, mean inefficiency was highest for for-profit hospitals and lowest for not-for-profit hospitals, with government hospitals falling in the middle. Moreover, between 1986 and 1991, both for-profit and government hospitals had significantly less improvement in efficiency than not-for-profit hospitals, all else equal.
-
For many years, average bed occupancy level has been the primary measure that has guided hospital bed capacity decisions at both policy and managerial levels. Even now, the common wisdom that there is an excess of beds nationally has been based on a federal target of 85% occupancy that was developed about 25 years ago. This paper examines data from New York state and uses queueing analysis to estimate bed unavailability in intensive care units (ICUs) and obstetrics units. ⋯ Furthermore, given the model's assumptions, these estimates are likely to be conservative. These findings illustrate that if service quality is deemed important, hospitals need to plan capacity based on standards that reflect the ability to place patients in appropriate beds in a timely fashion rather than on target occupancy levels. Doing so will require the collection and analysis of operational data-such as demands for and use of beds, and patient delays--which generally are not available.
-
Inquiry J Health Car · Jan 2003
Do "any willing provider" and "freedom of choice" laws affect HMO market share?
This study examines the effects of "any willing provider" (AWP) and "freedom of choice" (FOC) laws on the market share of health maintenance organizations (HMOs) in metropolitan statistical areas over the period 1989-95. We use pooled cross-section time-series regression techniques with year and state fixed effects. ⋯ The results suggest that FOC laws have a greater impact on market share than do AWP laws. More comprehensive regulation has a bigger impact than less encompassing laws, and laws limiting selective contracting with physicians are more effective in reducing HMO market share than are laws covering hospitals or pharmacies.