Inquiry J Health Car
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Inquiry J Health Car · Jan 1998
Reform of the Medicare AAPCC: learning from previous proposals. Average Adjusted Per Capita Costs.
Since 1982, Medicare has contracted with health maintenance organizations (HMOs) on a risk-contract basis, paying plans based on Average Adjusted Per Capita Costs (AAPCCs). The calculation of the AAPCCs has been criticized on several fronts. ⋯ Many of its provisions were enacted through the 1997 Balanced Budget Act. This paper models the effect of the earlier proposal on AAPCC rates and discusses the extent to which the proposal and the reforms in the 1995 Balanced Budget Act would address shortcomings identified in the original rate formula.
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Inquiry J Health Car · Jan 1998
Comparative StudyThe consequences of paying Medicare managed care plans their costs.
This study examines 1993 Medicare expenditures for enrollees in 63 managed care plans that were reimbursed on a cost basis. We find that government spending for enrollees in cost-reimbursed plans in 1993 was substantially greater than it would have been had these enrollees instead received care in traditional fee-for-service Medicare or in a Medicare risk plan. The increase was due entirely to the much higher expenditures for Part B services under cost reimbursement. The findings suggest that Medicare cost reimbursement of health plans should be eliminated or significantly modified.
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Inquiry J Health Car · Jan 1997
"Best hospitals": a description of the methodology for the Index of Hospital Quality.
Starting in 1991, U. S. News & World Report has published an annual cover story. "America's Best Hospitals," for which the National Opinion Research Center (NORC) has provided the underlying data. ⋯ This article reports on the theoretical framework and methodological design of the "Index of Hospital Quality" used in the U. S. News & World Report rankings.
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Inquiry J Health Car · Jan 1996
Does risk-adjusted readmission rate provide valid information on hospital quality?
The purpose of this study was to determine whether readmission rates, adjusted to account for differences in clinical characteristics of patients treated, provide valid information on hospital quality of care. Twelve clinical conditions were selected. Condition-specific models to predict readmission risk were estimated using Medicare UB-82 claims data. ⋯ My analysis found no support for this hypothesis. In each of the 12 clinical conditions studied, readmission rates of cases that received poor quality care were essentially the same as those whose care was judged acceptable. This was true both for readmission rates that were adjusted for patients' demographic and clinical characteristics, and for unadjusted rates, such as those typically displayed in hospital report cards.
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Inquiry J Health Car · Jan 1996
The effect of rural hospital closures on the financial performance of neighboring rural hospitals.
This study investigates how the closure of rural hospitals affected other rural hospitals. The empirical analysis examined whether being the neighbor of a closed rural hospital affected financial performance variables during the periods before and after closure. Before and after comparisons of surviving rural hospitals were made between 1985 and 1989 for closures in 1987 and between 1986 and 1990 for closures in 1988. The regression results showed that neighbors of closed rural hospitals typically did experience increased volume in comparison to non-neighbors, but the increased volume did not lead to reductions in average cost or to improved profitability, after controlling for other factors.