Health services research
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Health services research · Dec 2000
Comparative StudyUninsured status and out-of-pocket costs at midlife.
To investigate how baseline health insurance coverage affects subsequent out-of-pocket costs and utilization of health services over a two-year period. ⋯ The medically uninsured appear to avoid substantial out-of-pocket health care costs by using relatively few health services when they are not seriously ill, and then relying upon health care safety nets when they experience medical problems. These results suggest that the main impact of non-insurance at midlife is not to place the locus of responsibility for costly health care upon individuals. Instead, it discourages routine care and transfers the costs of care for severe health events to other payers. Our findings on the high cost of employment-based coverage are consistent with evidence that the proportion of workers accepting health benefits from employers has been declining in recent years.
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Health services research · Dec 2000
New opportunities, new approaches: serving children with special health care needs under SCHIP.
To identify models for caring for children with special health care needs (CSHCN) under the State Children's Health insurance Program (SCHIP) and to analyze the strengths and weaknesses of each. ⋯ The mainstream approach , wh ile aimed at providing comprehensive care for all children , could not identify CSHCN or monitor their care. Wrap-around models, while offering rich benefits to CSHCN, rely on providers to identify eligible children , with few referrals reported to date. Service carve outs preserve long-standing specialty systems of care for CSH CN but create challenges for care coordination . Specialized systems of care present challenges for capitation but appear to offer the most promise for comprehensive, coordinated care to CSHCN.
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Health services research · Dec 2000
Comparative StudyRecent trends in the financing of substance abuse treatment: implications for the future.
This article focuses on the implications of a recent study of substance abuse (SA) and mental health treatment expenditures for substance abuse treatment policy. Public and private expenditures for SA treatment are estimated and compared with those for mental health and all health care in the period between 1987 and 1997. ⋯ Evidence from this article and other research suggests that growth in SA expenditures has been contained relative to growth in all health spending. How savings from SA treatment are being invested and whether expenditure levels are appropriate to supply treatment of acceptable quality needs further study.
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To examine the effect of HMO penetration on physician retirement. ⋯ Our findings suggest that many older physicians have found it preferable to retire rather than adapt their practices to an environment with a high degree of managed care penetration . Because the number of physicians entering the older age categories will increase rapidly over the next 20 years, the growth of managed care and other influences on physician retirement will play an increasingly important role in determining the size of the physician workforce.