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Grantee Publication

Physician Fee Policy and Medicaid Program Costs [1]

Journal of Human Resources--March 2003
Vol. 32, No. 4
March 2003
Gruber, J., Adams, E.K., and J.P. Newhouse
pp. 611-34

We investigate the hypothesis that increasing access for the indigent to physician offices shifts care from hospital outpatient settings and lowers Medicaid costs (the so-called offset effect'). To evaluate this hypothesis we exploit a large increase in physician fees in the Tennessee Medicaid program, using Georgia as a control. We find that beneficiaries shifted care from clinics to offices, but that there was little or no shifting from hospital outpatient departments or emergency rooms. Thus, we find no offset effect in outpatient expenditures.

Grants: 
Evaluation of Natural Experiment to Raise Medicaid Fees for Physicians [2]
Topic: 
Access [3]
Topic: 
Costs and Cost Containment [4]
Topic: 
Medicaid and SCHIP [5]
Topic: 
Provider Payment and Behavior [6]
Topic: 
Vulnerable Populations [7]

What Do Nonprofits Maximize? Nonprofit Hospital Service Provision and Market Ownership [8]

NBER Working Paper Series-July 2007
Working Paper No. 13246
July 2007
Horwitz, J. and A. Nichols

Conflicting theories of the nonprofit firm have existed for several decades yet empirical research has not resolved these debates, partly because the theories are not easily testable but also because empirical research generally considers organizations in isolation rather than in markets.  Here we examine three types of hospitals -- nonprofit, for-profit, and government -- and their respective spillover effects.  We look at the effect of for-profit ownership share within markets in two ways, on the provision of medical services and on operating margins at the three types of hospit

Grants: 
Peer Pressure: Hospital Ownership Mix and Medical Service Provision [9]
Topic: 
Acute Care [10]
Topic: 
Legal and Regulatory Environment [11]
Topic: 
Organization and Supply of Care [12]

Focus on Locus: Evolution of Medicare's Local Coverage Policy [13]

Health Affairs--July/August 2003
Vol. 22, No. 4
July/August 2003
Foote, S.B.
pp. 137-46

Medicare relies on a highly decentralized local-contractor structure that emerged as a political compromise in 1965. Decisions regarding Medicare's coverage of new procedures and technologies are an important part of the program. A national coverage process exists, but Medicare's local contractors develop most coverage policies. Although an intense debate surrounds Medicare's local coverage process, there is little analysis to inform the discussion. To expand knowledge of local coverage policy, this paper traces its origins and evolution.

Grants: 
Evaluation of Medicare's Local Medical Review Policies for New Medical Technologies [14]
Topic: 
Benefit Design [15]
Topic: 
Legal and Regulatory Environment [11]
Topic: 
Medicare [16]

Volume Responses to Medicare Payment Reductions with Multiple Payers: A Test of the McGuire-Pauly Mode [17]

Health Economics
Vol. 7, No. 3
May 1998
Tai-Seale, M., Rice, T., and S.C. Stearns
pp. 199 - 219

The effects of changing financial incentives on physician's practice behaviour have long been of interest to researchers and policy makers. We test a model of physician volume response within the context of multiple payers developed by Thomas McGuire and Mark Pauly. A panel data set covering discharges from about 200 hospitals in the US over 45 months is used to carry out the empirical investigation.

Grants: 
Physician Response to Medicare Payment Reductions: Impacts on the Public and Private Sectors [18]
Topic: 
Legal and Regulatory Environment [11]
Topic: 
Medicare [16]
Topic: 
Provider Payment and Behavior [6]

Drug Use Patterns in Severely Mentally Ill Medicare Beneficiaries: Impact of Discontinuities in Drug Coverage [19]

Health Services Research-April 2008
Vol. 43, No. 2
April 2008
Simoni-Wastila, L., Zuckerman, I.H., Shaffer, T., Blanchette, C.M., and B. Stuart
pp. 496-514

Objective: To describe the extent of drug coverage among severely mentally ill Medicare beneficiaries and to determine whether and to what extent discontinuities in prescription drug coverage influence the use of medications used to treat serious mental health conditions.

Data Source: 1997–2001 Medicare Current Beneficiary Surveys.

Grants: 
Establishing the Value of Stable Prescription Coverage for Medicare Beneficiaries [20]
Topic: 
Behavioral Health [21]
Topic: 
Consumer Behavior [22]
Topic: 
Medicare [16]
Topic: 
Prescription Drugs [23]

Corporate Management of Quality in Employee Health Plans [24]

Health Care Management Review
Vol. 28, No. 1
January 2003
Maxwell, J. and P. Temin
pp. 27-40.

As large companies move their employees into managed care, they must concern themselves with the quality and price of their employees' health care. Based on a survey of Fortune 500 companies, we show that most are integrating several aspects of quality into their purchasing and contracting decisions by focusing on three dimensions--customer service, network composition, and clinical quality. Companies focus on the customer service dimension while the medical community emphasizes clinical quality.

Grants: 
The Transformation of Corporate Health Care Purchasing [25]
Topic: 
Purchasing [26]
Topic: 
Quality of Care [27]

Why Are Managed Care Plans Less Expensive: Risk Selection, Utilization, or Reimbursement? [28]

The Journal of Risk and Insurance-March 2004
March 2004
Polsky, D. and N. Nicholson

This article develops a new method of decomposing the cost difference between HMO and non-HMO plans into observed risk selection, unobserved risk selection, utilization differences, and differences in provider reimbursement rates. We implement this method using a large national sample of employer-sponsored health insurance enrollees from the Community Tracking Study Household Survey.

Grants: 
Research on Risk Selection in Employer-sponsored Health Insurance [29]
Topic: 
Costs and Cost Containment [4]
Topic: 
Managed Care [30]
Topic: 
Risk Adjustment [31]

Do Consumer-Directed Health Plans Drive Changes in Enrollees' Health Care Behavior? [32]

Health Affairs-July/August 2008
Vol. 27, No. 4
July/August 2008
Dixon, A., Greene, J., and J. Hibbard
pp. 1120-31

Using panel data from two surveys of employees at one large employer from 2004 and 2005, this paper examines consumer-directed health plans’ (CDHPs’) influence on the use of health-related information and health services. We compare enrollees in a high-deductible CDHP, a lower-deductible CDHP, and a preferred provider organization (PPO). Enrollees in the lower-deductible CDHP were more likely than enrollees in the other plans to start using information.

Grants: 
How Valid are the Assumptions Underlying Consumer-Driven Health Plans? [33]
Topic: 
Benefit Design [15]
Topic: 
Consumer Behavior [22]
Topic: 
Insurance Coverage [34]

Revisiting the Appropriateness of Carotid Endarterectomy [35]

Stroke - June 2003
Vol. 34, No. 6
June 2003
Halm, E.A., Chassin, M.R., Tuhrim, S., Hollier, L.H., Popp, A.J., Ascher, E., Dardik, H., Faust, G., and T.S. Riles
pp. 1464-71

In the 1980s, carotid endarterectomy was controversial because proof of efficacy was lacking, complication rates were high, and one third of cases were reported to be inappropriate.  Since publication of several randomized controlled trials (RCTs), rates of carotid endarterectomy have doubled nationwide.  This study assess the appropriateness and use of carotid endarterectomy since publication of the RCTs. 

View full article [36]...

Grants: 
The Impact of Managed Care on the Appropriateness and Outcomes of Carotid Endarterectomy [37]
Topic: 
Quality of Care [27]

Financial Pressure and Competition: Changes in Hospital Efficiency and Cost-Shifting Behavior [38]

Medical Care
Vol. 34, No. 3
March 1996
Hadley, J., Zuckerman, S., and L. Iezzoni
pp. 205-19

Using data from the American Hospital Association and the Medicare program, the authors analyzed the effects of financial pressure and market competition on changes in several measures of performance of 1,435 acute care hospitals between 1987 and 1989. Over the observation period, the least profitable hospitals constrained their growth in total expenses to half that for the most profitable hospitals (13.3% versus 27.6%) by limiting the growth of their staffs and their total assets.

Grants: 
Efficiency/Quality/Outcome Trade-offs in Medicare's Prospective Payment System [39]
Topic: 
Acute Care [10]
Topic: 
Costs and Cost Containment [4]
Topic: 
Organization and Supply of Care [12]
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Links:
[1] http://www.hcfo.org/publications/physician-fee-policy-and-medicaid-program-costs
[2] http://www.hcfo.org/grants/evaluation-natural-experiment-raise-medicaid-fees-physicians
[3] http://www.hcfo.org/topics/access
[4] http://www.hcfo.org/topics/costs-and-cost-containment
[5] http://www.hcfo.org/topics/medicaid-and-schip
[6] http://www.hcfo.org/topics/provider-payment-and-behavior
[7] http://www.hcfo.org/topics/vulnerable-populations
[8] http://www.hcfo.org/publications/what-do-nonprofits-maximize-nonprofit-hospital-service-provision-and-market-ownership
[9] http://www.hcfo.org/grants/peer-pressure-hospital-ownership-mix-and-medical-service-provision
[10] http://www.hcfo.org/topics/acute-care
[11] http://www.hcfo.org/topics/legal-and-regulatory-environment
[12] http://www.hcfo.org/topics/organization-and-supply-care
[13] http://www.hcfo.org/publications/focus-locus-evolution-medicares-local-coverage-policy-0
[14] http://www.hcfo.org/grants/evaluation-medicares-local-medical-review-policies-new-medical-technologies
[15] http://www.hcfo.org/topics/benefit-design
[16] http://www.hcfo.org/topics/medicare
[17] http://www.hcfo.org/publications/volume-responses-medicare-payment-reductions-multiple-payers-test-mcguire-pauly-mode
[18] http://www.hcfo.org/grants/physician-response-medicare-payment-reductions-impacts-public-and-private-sectors
[19] http://www.hcfo.org/publications/drug-use-patterns-severely-mentally-ill-medicare-beneficiaries-impact-discontinuities-d
[20] http://www.hcfo.org/grants/establishing-value-stable-prescription-coverage-medicare-beneficiaries
[21] http://www.hcfo.org/topics/behavioral-health
[22] http://www.hcfo.org/topics/consumer-behavior
[23] http://www.hcfo.org/topics/prescription-drugs
[24] http://www.hcfo.org/publications/corporate-management-quality-employee-health-plans
[25] http://www.hcfo.org/grants/transformation-corporate-health-care-purchasing
[26] http://www.hcfo.org/topics/purchasing
[27] http://www.hcfo.org/topics/quality-care
[28] http://www.hcfo.org/publications/why-are-managed-care-plans-less-expensive-risk-selection-utilization-or-reimbursement
[29] http://www.hcfo.org/grants/research-risk-selection-employer-sponsored-health-insurance
[30] http://www.hcfo.org/topics/managed-care
[31] http://www.hcfo.org/topics/risk-adjustment
[32] http://www.hcfo.org/publications/do-consumer-directed-health-plans-drive-changes-enrollees-health-care-behavior
[33] http://www.hcfo.org/grants/how-valid-are-assumptions-underlying-consumer-driven-health-plans
[34] http://www.hcfo.org/topics/insurance-coverage
[35] http://www.hcfo.org/publications/revisiting-appropriateness-carotid-endarterectomy
[36] http://stroke.ahajournals.org/cgi/content/full/34/6/1464
[37] http://www.hcfo.org/grants/impact-managed-care-appropriateness-and-outcomes-carotid-endarterectomy
[38] http://www.hcfo.org/publications/financial-pressure-and-competition-changes-hospital-efficiency-and-cost-shifting-behavi
[39] http://www.hcfo.org/grants/efficiencyqualityoutcome-trade-offs-medicares-prospective-payment-system
[40] http://www.hcfo.org/taxonomy/term/4/all
[41] http://www.hcfo.org/taxonomy/term/4/all?page=30
[42] http://www.hcfo.org/taxonomy/term/4/all?page=27
[43] http://www.hcfo.org/taxonomy/term/4/all?page=28
[44] http://www.hcfo.org/taxonomy/term/4/all?page=29
[45] http://www.hcfo.org/taxonomy/term/4/all?page=32
[46] http://www.hcfo.org/taxonomy/term/4/all?page=33
[47] http://www.hcfo.org/taxonomy/term/4/all?page=34
[48] http://www.hcfo.org/taxonomy/term/4/all?page=35
[49] http://www.hcfo.org/taxonomy/term/4/all?page=48