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Findings Brief

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The Medicaid Undercount: Real or Perceived Bias in Estimates of Coverage in General Population Surveys

Key Findings: 
  • Population surveys that collect point-in- time coverage information do a good job of measuring and determining those with and without health insurance.
  • The small amount of bias created by an undercount among Medicaid enrollees does not greatly undermine the validity of estimates of the uninsured or the policies resulting from that information.
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HCFOfindings0908.pdf
Vol. XI, No. 6
September 2008
HCFO

Does the undercount of individuals with Medicaid coverage bias the estimates of the number of uninsured? Kathleen Thiede Call, Ph.D., examined whether limitations in population surveys and the collection of administrative data lead to an undercount in the number of individuals with Medicaid coverage and found that the small amount of bias created by an undercount among Medicaid enrollees does not greatly undermine the validity of estimates of the uninsured or the policies resulting from that information. Learn more in the HCFO Findings Brief.

Grants: 
The Medicaid Undercount: Real or Perceived Bias in Estimates of Coverage in General Population Surveys
Topic: 
Legal and Regulatory Environment
Topic: 
Medicaid and SCHIP
Topic: 
Vulnerable Populations

The Impact of Hospital Ownership: Looking for Consistency Among Conflicting Findings

Key Findings: 
  • Much of the variation in hospital ownership effect on financial performance can be explained by a study’s research focus and methodology.
  • The majority of studies reported no statistically significant difference between not-for-profit and for-profit hospitals in quality of care defined as mortality or other adverse events.
  • Studies that did show that ownership had an impact on quality of care were influenced by their institutional context, including differences across regions, markets, and time period.
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HCFOfindings0208.pdf
Vol. XI, No. 2
February 2008
HCFO

Does for-profit or not-for-profit status of a hospital impact its performance and quality of care? Karen Eggleston, Ph.D., and colleagues conducted a meta-analysis of the empirical literature and found that much of the variation in hospital ownership effect on financial performance can be explained by a study’s research focus and methodology. Learn more in the HCFO Findings Brief.

Grants: 
Hospital Ownership and Performance: An Integrative Research Review
Topic: 
Legal and Regulatory Environment
Topic: 
Organization and Supply of Care
Topic: 
Provider Payment and Behavior
Topic: 
Quality of Care

Surviving the Perfect Storm: Impacts of Benefit Reductions and Increased Cost Sharing in a Medicaid Program

Key Findings: 
  • Changes to the Oregon Health Plan resulted in disenrollment by the lowest income individuals.
  • Implementing co-payments created no net savings for the Oregon Health Plan.
  • Changes to the Oregon Health Plan resulted in an abrupt and sustained increase in ED visits by the uninsured.
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HCFOfindings0708.pdf
Vol. XI, No. 4
July 2008
HCFO

Will changes by state Medicaid programs result in harmful or beneficial consequences to enrollees? Jeanene Smith, M.D., and colleagues conducted a “natural experiment” testing the impact of cost-sharing measures and benefit reductions on Oregon Health Plan beneficiaries and found that changes in the benefit design resulted in decreased enrollment by the lowest income individuals and an abrupt and sustained increase in ED visits by the uninsured. Learn more in the HCFO Findings Brief.

Grants: 
Surviving the Perfect Storm: Impacts of Benefit Reductions and Increased Cost Sharing in a Medicaid Program
Topic: 
Access
Topic: 
Benefit Design
Topic: 
Consumer Behavior
Topic: 
Medicaid and SCHIP
Topic: 
Vulnerable Populations

HCFO Findings Brief: Should Healthy Medicare Beneficiaries Postpone Enrollment in Part D?

Key Findings: 
  • Total lifetime expected out-of-pocket costs are minimized if healthy 65-year-old Medicare beneficiaries enroll in Part D immediately upon eligibility rather than waiting until they contract a drug-intensive condition.
  • The savings from early enrollment are greater for females than for males.
  • The late enrollment penalty for Medicare Part D provides an important incentive for early enrollment, and eliminating the late enrollment penalty would create a significant cost advantage for postponed enrollment, especially for men.
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HCFOfindings1108no9.pdf
November 2008
HCFO

Is it cost-effective for “healthy” Medicare beneficiaries, who do not regularly take prescription drugs, to enroll in Part D as soon as they are eligible? Bryan Dowd, Ph.D., and colleagues examined the differences in lifetime out-of-pocket prescription drug expenditures and found that total lifetime expected out-of-pocket costs are minimized if healthy 65-year-old Medicare beneficiaries enroll in Part D immediately upon eligibility rather than waiting until they contract a drug-intensive condition. Learn more in the HCFO Findings Brief.

Grants: 
Study on Informed Choice of Drug Coverage for Medicare Beneficiaries
Topic: 
Medicare
Topic: 
Prescription Drugs

Reducing the Administrative Burden of Health Care Quality Reporting

Key Findings: 
  • While quality performance measurement and reporting have the potential to improve the quality of health care and reduce costs, these activities can pose a significant administrative and financial burden on participating hospitals.
  • Hospitals are adopting a variety of strategies to manage quality measurement and reporting demands.
  • Better coordination may be the key to successful quality reporting.
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HCFOfindings1208.pdf
December 2008
HCFO

How great are the financial and administrative burdens of quality measurement and reporting on hospitals? Paul Ginsburg, Ph.D., and colleagues examined hospitals’ quality reporting activities, the strategies hospitals use to manage the demands associated with reporting activities, and the role of external stakeholders in streamlining quality reporting demands.

Grants: 
Strategies to Reduce Health Care Providers’ Administrative Burden Related to Quality Performance Measurement and Reporting
Topic: 
Organization and Supply of Care
Topic: 
Quality of Care

Physician Payment: Is There a Better Way to Pay?

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HCFOfindings0507.pdf
Vol. X, No. 5
May 2007
HCFO

What forms of physician payment can improve quality, contain costs, and maintain or improve access to health care? This findings brief discusses several approaches to physician payment, both tried and evolving, in terms of their ability to help redefine the goals of reimbursement. Learn more in the HCFO Findings Brief.

Topic: 
Access
Topic: 
Costs and Cost Containment
Topic: 
Provider Payment and Behavior
Topic: 
Quality of Care

Pharmacogenomics: an Assessment of Market Conditions and Competition

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HCFOfindings_pharmacogenomics.pdf
Vol. X, No. 3
March 2007
HCFO

How can pharmacogenomics (PGx) be introduced into the current health care market? Louis F. Rossiter, Ph.D., examined the current market system to determine whether PGx could flourish in the current financing, delivery, and payment environment and found that the current U.S. payment system is not designed for PGx and therefore inadequate for PGx products and services to meet their maximum treatment potential. Learn more in the HCFO Findings Brief.

Grants: 
The Emerging Market for Pharmacogenomics and Health Care Competition
Topic: 
Costs and Cost Containment
Topic: 
Organization and Supply of Care
Topic: 
Prescription Drugs

Meeting the Future Long-Term Care Needs of the Baby Boomers

Key Findings: 
  • Frail older adults are one of the most vulnerable groups in the nation. Disproportionately female, widowed, and in their 80s and 90s, most older people with disabilities living outside of nursing homes have little education and limited financial resources. Providing help can overwhelm caregivers.
  • Even under the most optimistic scenario long-term care burdens on families and institutions will increase substantially in coming decades. If disability rates decrease steadily and substantially over time the number of older adults using paid home care will increase by three-fourths between 2000 and 2040 and the number in nursing homes will increase by two-thirds. Total paid home care hours will more than triple.
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HCFOfindings0707.pdf
Vol. X, No. 6
July 2007
HCFO

What will be the impact of the aging baby boomer generation on long-term care needs? Richard Johnson, Ph.D., Joshua Wiener, Ph.D., and colleagues examined the impact of the changing structure of families on paid helpers and institutions and found that the burden on families, caregivers, and institutions will increase substantially in the coming decades. Learn more in the HCFO Findings Brief.

Grants: 
Meeting the Future Long-Term Care Needs of the Baby Boomers: How the Changing Structure of Families Will Affect Paid Helpers and Institutions
Topic: 
Long-Term Care
Topic: 
Organization and Supply of Care
Topic: 
Vulnerable Populations

Medicare Spending on HMOs and Stand-Alone Drug Plans: What is it Worth to Beneficiaries?

Key Findings: 
  • Medicare beneficiaries value the expansion of stand-alone prescription drug plans more than they value the expansion of HMOs.
  • The addition of subsidized stand-alone prescription drug plans generates nine times as much value per government dollar as the increase in payments to HMOs.
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HCFOfindings1108.pdf
November 2008
HCFO

What are the costs and benefits of supporting private Medicare health insurance plans? Steven D. Pizer, Ph.D., and colleagues examined how well stand-alone prescription drug plans and increased payments to HMOs improved the welfare of Medicare beneficiaries per dollar of additional federal spending. They found that the stand-alone prescription drug plans generate more value per government dollar. Learn more in the HCFO Findings Brief.

Grants: 
Measuring the Costs and Benefits of Medicare Private Fee-for-Service
Topic: 
Benefit Design
Topic: 
Insurance Coverage
Topic: 
Managed Care
Topic: 
Medicare

Medicare Advantage and the Impact of Medicare HMOs on Inpatient Utilization

Key Findings: 
  • Health maintenance organizations (HMOs) decrease inpatient utilization for Medicare enrollees.
  • California group and staff HMO enrollees used 18 percent fewer inpatient days than had they continued in Medicare fee-for-service (FFS) plans, with an 11 percent reduction for independent practice asociation (IPA) HMO enrollees.
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HCFOfindings1007.pdf
Vol. X, No. 9
October 2007
HCFO

Do Medicare Advantage plans use health care resources efficiently? Glenn Melnick, Ph.D., and colleagues examined the differences in hospital utilization for Medicare FFS and Medicare risk HMO enrollees and found that HMOs decrease inpatient utilization for Medicare enrollees. Learn more in the HCFO Findings Brief.

Grants: 
Medicare Risk-Contracting: Impact on Access and Quality for Medicare HMO Enrollees and Vulnerable Populations
Topic: 
Access
Topic: 
Insurance Coverage
Topic: 
Managed Care
Topic: 
Medicare
Topic: 
Quality of Care
Topic: 
Vulnerable Populations
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