Grantee Publication

Medicaid Managed Care and the Care of Patients Hospitalized for Acute Myocardial Infarction

American Heart Journal
Vol. 139, No. 4
April 2000
Sloan, F.A., Rankin, P., Whellan, D., and C. Conover
pp. 567-76

BACKGROUND: TennCare, beginning in January 1994, channeled all Medicaid-eligible patients into managed care while expanding Medicaid coverage to large numbers of previously uninsured patients. We assessed the impact of TennCare on (1) coronary revascularization of patients who had had an acute myocardial infarction (AMI), (2) the likelihood of the patient having a usual provider of care after discharge from the hospital, and (3) health and functional status 1 to 3 years after the index AMI.

Prescription Drug Spending for Medicare+Choice Beneficiaries in the Last Year of Life

Journal of Palliative Medicine - August 2006
Vol. 9, No. 4
August 2006
Fahlman, C., Lynn, J., Doberman, D., Gabel, J., and M. Finch
pp. 884-93

Background. In 2006, Medicare implemented its prescription benefit plan. Therefore, insights into medication costs at the end of life may help guide clinicians to navigate Medicare Part D coverage for chronically ill individuals.

Objectives. We examined drug spending by disease and demographics for Medicare+Choice (M+C) beneficiaries in the last year of life (LYOL).

Tracking Career Satisfaction and Perceptions of Quality Among US Obstetricians and Gynecologists

Obstetrics and Gynecology--September 2003
Vol. 102, No. 3
September 2003
Kravitz, R.L., Leigh, J.P., Samuels, S.J., Schembri, M., and W.M. Gilbert
pp. 463-70

OBJECTIVE: To assess recent trends in professional satisfaction, perceptions of ability to provide high-quality care, and perceptions of ability to obtain needed services for patients in a national sample of obstetricians and gynecologists; to compare obstetrician-gynecologists with physicians in other specialties; and to identify demographic, professional, and practice characteristics associated with high career satisfaction.

Impact of Medicare Payment Reductions on Access to Surgical Services

Health Services Research
Vol. 30, No. 5
December 1995
Mitchell, J.B. and J. Cromwell
pp. 637-55

OBJECTIVE. This study evaluates the impact of surgical fee reductions under Medicare on the utilization of surgical services. DATA SOURCES. Medicare physician claims data were obtained from 11 states for a five-year time period (1985-1989). STUDY DESIGN. Under OBRA-87, Medicare reduced payments for 11 surgical procedures. A fixed effects regression method was used to determine the impact of these payment reductions on access to care for potentially vulnerable Medicare beneficiaries: joint Medicaid-eligibles, blacks, and the very old. DATA COLLECTION/EXTRACTION METHODS.

An Analysis of Unobserved Selection in an Inpatient Diagnostic Cost Group Model

Health Services & Outcomes Research Methodology-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

The study assesses unobserved selection bias in an inpatient diagnostic cost group (DCG) model similar to Medicare's Principal Inpatient Diagnostic Cost Group (PIP-DCG) risk adjustment model using a unique data set that contains hospital discharge records for both FFS and HMO Medicare beneficiaries in California from 1994 to 1996. We use a simultaneous equations model that jointly estimates HMO enrollment and subsequent hospital use to test the existence of unobserved selection and estimate the true HMO effect.

The Impact and Enforcement of Prudent Layperson Laws

Annals of Emergency Medicine--2003
Vol. 43, No. 5
Hall, M.A.
pp. 558-66

STUDY OBJECTIVE: Almost every state has enacted a "prudent layperson" standard for determining insurance coverage for emergency department (ED) services. This study evaluates whether these laws are achieving their goals or causing unintended side effects. METHODS: Six states were selected for in-depth case studies to represent a range of market, demographic, and legal conditions. In each state, 11 to 15 interviews were conducted with insurers, regulators, providers, employers, patient advocates, and industry observers, for a total of 87 interviews.

HMO Market Structure and Performance: 1985-1995

Health Affairs
Vol. 16, No. 6
November 1997
Wholey, D., Christianson, J., Engberg, J., and C. Bryce
pp. 75-84

This paper estimates the effect of market structure on hospital days and ambulatory visits in independent practice associations (IPAs) and group-model health maintenance organizations (HMOs) where market structure is measured by HMO penetration and the number of HMOs operating in a market. There was a steady decline in inpatient use in HMOs during the study period and a steady increase in use of ambulatory care. In multivariate analyses, inpatient use is significantly higher in IPAs, but there is no difference in ambulatory use.

Hospital Ownership and Quality of Care: What Explains the Different Results in the Literature?

Health Economics
Vol. 17, No. 12
January 11, 2008
Eggleston, K., Shen, Y.C., Lau, J., Schmid, C.H., and J. Chan
pp. 1345-62

Does quality of care systematically differ among government-owned, private not-for-profit, and for-profit hospitals? A large empirical literature provides conflicting evidence. Through quantitative review of 46 studies since 1990, we find that several study features that can explain divergent results: analytic methods, disease studied, and data sources. For unprofitable care, how studies handle market competition and regional differences account for substantial variation.

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