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<title>List of Past Articles</title>
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<generator>Centers for Medicare and Medicaid Services</generator><item><title>Cost of Lifetime Immunosuppression Coverage for Kidney Transplant Recipients</title><pubDate>Mon, 04 Nov 2019 02:42:55 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/statistics-trends-and-reports/archives/hcfr/list-of-past-articles-items/cms1222307</link><guid>https://www.cms.gov//research-statistics-data-and-systems/statistics-trends-and-reports/archives/hcfr/list-of-past-articles-items/cms1222307</guid><description><![CDATA[<p>page_range: 95</p><p>primary_author: Page, T. F.</p><p>title: Cost of Lifetime Immunosuppression Coverage for Kidney Transplant Recipients</p><p>volume: 30</p><p>year_period: 2008 Winter</p>]]></description></item><item><title>Payment Reduction and Medicare Private Fee­for­Service Plans</title><pubDate>Mon, 04 Nov 2019 02:42:48 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/2009spring15</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/2009spring15</guid><description><![CDATA[<p>page_range: 10</p><p>primary_author: Austin B. Frakt</p><p>title: Payment Reduction and Medicare Private Fee­for­Service Plans</p><p>volume: 30</p><p>year_period: 2009 Spring</p>]]></description></item><item><title>Linking Tumor Registry and Medicaid Claims
to Evaluate Cancer Care Delivery</title><pubDate>Mon, 04 Nov 2019 02:42:46 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/2009summer61</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/2009summer61</guid><description><![CDATA[<p>page_range: 13</p><p>primary_author: Deborah Schrag</p><p>title: Linking Tumor Registry and Medicaid Claims
to Evaluate Cancer Care Delivery</p><p>volume: 30</p><p>year_period: 2009 Summer</p>]]></description></item><item><title>Toward Understanding EHR Use in Small Physician
Practices</title><pubDate>Mon, 04 Nov 2019 02:42:45 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/2009fall11</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/2009fall11</guid><description><![CDATA[<p>page_range: 12</p><p>primary_author: Felt-Lisk</p><p>title: Toward Understanding EHR Use in Small Physician
Practices</p><p>volume: 31</p><p>year_period: 2009 Fall</p>]]></description></item><item><title>Estimating the Costs of Potentially Preventable
Hospital Acquired Complications</title><pubDate>Mon, 04 Nov 2019 02:42:45 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/2009summer17</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/2009summer17</guid><description><![CDATA[<p>page_range: 16</p><p>primary_author: Richard L. Fuller</p><p>title: Estimating the Costs of Potentially Preventable
Hospital Acquired Complications</p><p>volume: 30</p><p>year_period: 2009 Summer</p>]]></description></item><item><title>Medicaid Expansions and the Insurance Coverage
of Poor Teenagers</title><pubDate>Mon, 04 Nov 2019 02:42:45 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/2009fall23</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/2009fall23</guid><description><![CDATA[<p>page_range: 12</p><p>primary_author: Leininger,</p><p>title: Medicaid Expansions and the Insurance Coverage
of Poor Teenagers</p><p>volume: 31</p><p>year_period: 2009 Fall</p>]]></description></item><item><title>Financing Health Care: Businesses, Households, and Governments, 1987-2003</title><pubDate>Mon, 04 Nov 2019 02:42:45 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/2005julywe</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/2005julywe</guid><description><![CDATA[<p>page_range: 26</p><p>primary_author: Cathy A. Cowan, M.B.A.</p><p>title: Financing Health Care: Businesses, Households, and Governments, 1987-2003</p><p>volume: Web Exclusive</p><p>year_period: 2005 July</p>]]></description></item><item><title>Use and Knowledge of the New Enrollee “Welcome to Medicare” Physical Examination Benefit</title><pubDate>Mon, 04 Nov 2019 02:42:44 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/2009spring71</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/2009spring71</guid><description><![CDATA[<p>page_range: 6</p><p>primary_author: Cara A. Petroski</p><p>title: Use and Knowledge of the New Enrollee “Welcome to Medicare” Physical Examination Benefit</p><p>volume: 30</p><p>year_period: 2009 Spring</p>]]></description></item><item><title>Age Estimates in the National Health Accounts</title><pubDate>Mon, 04 Nov 2019 02:42:44 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/2004decwe</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/2004decwe</guid><description><![CDATA[<p>page_range: 16</p><p>primary_author: Sean P. Keehan, M.A.</p><p>title: Age Estimates in the National Health Accounts</p><p>volume: Web Exclusive</p><p>year_period: 2004 December</p>]]></description></item><item><title>Medicare Financial Status, Budget Impact, and Sustainability—Which Concept is Which?</title><pubDate>Mon, 04 Nov 2019 02:42:44 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/2009spring77</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/2009spring77</guid><description><![CDATA[<p>page_range: 14</p><p>primary_author: Richard S. Foster, F.S.A.</p><p>title: Medicare Financial Status, Budget Impact, and Sustainability—Which Concept is Which?</p><p>volume: 30</p><p>year_period: 2009 Spring</p>]]></description></item><item><title>The Medicare Hospice Payment System:
A Consideration of Potential Refinements</title><pubDate>Mon, 04 Nov 2019 02:42:44 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/2009summer47</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/2009summer47</guid><description><![CDATA[<p>page_range: 13</p><p>primary_author: Nancy Nicosia</p><p>title: The Medicare Hospice Payment System:
A Consideration of Potential Refinements</p><p>volume: 30</p><p>year_period: 2009 Summer</p>]]></description></item><item><title>Clinician Feedback on Using Episode Groupers with
Medicare Claims Data</title><pubDate>Mon, 04 Nov 2019 02:42:44 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/2009fall51</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/2009fall51</guid><description><![CDATA[<p>page_range: 11</p><p>primary_author: Fred Thomas</p><p>title: Clinician Feedback on Using Episode Groupers with
Medicare Claims Data</p><p>volume: 31</p><p>year_period: 2009 Fall</p>]]></description></item><item><title>Pay-for-Performance in Nursing Homes</title><pubDate>Mon, 04 Nov 2019 02:42:44 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/2009spring1</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/2009spring1</guid><description><![CDATA[<p>page_range: 13</p><p>primary_author: Becky A. Briesacher</p><p>title: Pay-for-Performance in Nursing Homes</p><p>volume: 30</p><p>year_period: 2009 Spring</p>]]></description></item><item><title>Clinician Feedback on Using Episode Groupers with Medicare Claims Data</title><pubDate>Mon, 04 Nov 2019 02:42:44 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/2009octwe</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/2009octwe</guid><description><![CDATA[<p>page_range: 11</p><p>primary_author: Fred Thomas, Ph.D.</p><p>title: Clinician Feedback on Using Episode Groupers with Medicare Claims Data</p><p>volume: Web Exclusive</p><p>year_period: 2009 October</p>]]></description></item><item><title>Colon Cancer Treatment Costs for Medicare
and Dually Eligible Beneficiaries</title><pubDate>Mon, 04 Nov 2019 02:42:42 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/2009fall35</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/2009fall35</guid><description><![CDATA[<p>page_range: 16</p><p>primary_author: Luo</p><p>title: Colon Cancer Treatment Costs for Medicare
and Dually Eligible Beneficiaries</p><p>volume: 31</p><p>year_period: 2009 Fall</p>]]></description></item><item><title>Psychometric Properties of an Instrument to Assess Medicare Beneficiaries’ Prescription Drug Plan Experiences</title><pubDate>Mon, 04 Nov 2019 02:42:42 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/2009spring41</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/2009spring41</guid><description><![CDATA[<p>page_range: 13</p><p>primary_author: Steven C. Martino</p><p>title: Psychometric Properties of an Instrument to Assess Medicare Beneficiaries’ Prescription Drug Plan Experiences</p><p>volume: 30</p><p>year_period: 2009 Spring</p>]]></description></item><item><title>Developing Financial Benchmarks for Critical Access Hospitals</title><pubDate>Mon, 04 Nov 2019 02:42:42 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/2009spring55</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/2009spring55</guid><description><![CDATA[<p>page_range: 15</p><p>primary_author: George H. Pink, Ph.D</p><p>title: Developing Financial Benchmarks for Critical Access Hospitals</p><p>volume: 30</p><p>year_period: 2009 Spring</p>]]></description></item><item><title>Medicaid Consumers and Informed Decisionmaking</title><pubDate>Mon, 04 Nov 2019 02:42:42 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/2009spring25</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/2009spring25</guid><description><![CDATA[<p>page_range: 16</p><p>primary_author: Jessica Greene, Ph.D</p><p>title: Medicaid Consumers and Informed Decisionmaking</p><p>volume: 30</p><p>year_period: 2009 Spring</p>]]></description></item><item><title>Need for Risk Adjustment in Adapting Episode Grouping Software to Medicare Data</title><pubDate>Mon, 04 Nov 2019 02:42:42 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/2009summer33</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/2009summer33</guid><description><![CDATA[<p>page_range: 14</p><p>primary_author: Thomas MaCurdy</p><p>title: Need for Risk Adjustment in Adapting Episode Grouping Software to Medicare Data</p><p>volume: 30</p><p>year_period: 2009 Summer</p>]]></description></item><item><title>Redesigning the Medicare Inpatient PPS to Reduce
Payments to Hospitals with High Readmission Rates</title><pubDate>Mon, 04 Nov 2019 02:42:42 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/2009summer1</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/2009summer1</guid><description><![CDATA[<p>page_range: 15</p><p>primary_author: Richard F. Averill</p><p>title: Redesigning the Medicare Inpatient PPS to Reduce
Payments to Hospitals with High Readmission Rates</p><p>volume: 30</p><p>year_period: 2009 Summer</p>]]></description></item><item><title>Ventilator-Associated Pneumonia among Elderly Medicare
Beneficiaries in Long-Term Care Hospitals</title><pubDate>Mon, 04 Nov 2019 02:42:42 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/2009fall1</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/2009fall1</guid><description><![CDATA[<p>page_range: 10</p><p>primary_author: William Buczko</p><p>title: Ventilator-Associated Pneumonia among Elderly Medicare
Beneficiaries in Long-Term Care Hospitals</p><p>volume: 31</p><p>year_period: 2009 Fall</p>]]></description></item><item><title>Impact of Nonresponse on Medicare Current Beneficiary Survey Estimates</title><pubDate>Mon, 04 Nov 2019 02:28:19 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1205551</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1205551</guid><description><![CDATA[<p>page_range: 71-93</p><p>primary_author: Kautter, J.</p><p>title: Impact of Nonresponse on Medicare Current Beneficiary Survey Estimates</p><p>volume: 27</p><p>year_period: 2006 Summer</p>]]></description></item><item><title>Cigarette Smoking and Health-Related Quality of Life inMedicare Beneficiaries</title><pubDate>Mon, 04 Nov 2019 02:28:19 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1216289</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1216289</guid><description><![CDATA[<p>page_range: 57</p><p>primary_author: Hays, R. D.</p><p>title: Cigarette Smoking and Health-Related Quality of Life inMedicare Beneficiaries</p><p>volume: 29</p><p>year_period: 2008 Summer</p>]]></description></item><item><title>Disparities in HRQOL of Cancer Survivors and Non-Cancer Managed Care Enrollees</title><pubDate>Mon, 04 Nov 2019 02:28:19 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1216287</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1216287</guid><description><![CDATA[<p>page_range: 23</p><p>primary_author: Clauser, S. B.</p><p>title: Disparities in HRQOL of Cancer Survivors and Non-Cancer Managed Care Enrollees</p><p>volume: 29</p><p>year_period: 2008 Summer</p>]]></description></item><item><title>Impact of HMO Withdrawals on Vulnerable Medicare Beneficiaries</title><pubDate>Mon, 04 Nov 2019 02:28:19 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1196572</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1196572</guid><description><![CDATA[<p>page_range: 5-30</p><p>primary_author: Schoenman, J. A.</p><p>title: Impact of HMO Withdrawals on Vulnerable Medicare Beneficiaries</p><p>volume: 26</p><p>year_period: 2005 Spring</p>]]></description></item><item><title>Public Reporting of Hospital Patient Satisfaction: The Rhode Island Experience</title><pubDate>Mon, 04 Nov 2019 02:28:19 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1214317</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1214317</guid><description><![CDATA[<p>page_range: 51-70</p><p>primary_author: Barr, Judith K.</p><p>title: Public Reporting of Hospital Patient Satisfaction: The Rhode Island Experience</p><p>volume: 23</p><p>year_period: 2002 Summer</p>]]></description></item><item><title>Combining Health Plan Performance Indicators into Simpler Composite Measures</title><pubDate>Mon, 04 Nov 2019 02:28:19 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1214318</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1214318</guid><description><![CDATA[<p>page_range: 101-115</p><p>primary_author: Zaslavsky, Alan M.</p><p>title: Combining Health Plan Performance Indicators into Simpler Composite Measures</p><p>volume: 23</p><p>year_period: 2002 Summer</p>]]></description></item><item><title>Risk Adjustment and the Health of the Medicare HMO Population</title><pubDate>Mon, 04 Nov 2019 02:28:19 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1214431</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1214431</guid><description><![CDATA[<p>page_range: 275-280</p><p>primary_author: Aber, Meredith</p><p>title: Risk Adjustment and the Health of the Medicare HMO Population</p><p>volume: 21</p><p>year_period: 2000 Spring</p>]]></description></item><item><title>Information Needs and Preferences of the Medicare Population with Vision Loss</title><pubDate>Mon, 04 Nov 2019 02:28:19 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1214433</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1214433</guid><description><![CDATA[<p>page_range: 181-183</p><p>primary_author: Rubenstein, Carol</p><p>title: Information Needs and Preferences of the Medicare Population with Vision Loss</p><p>volume: 22</p><p>year_period: 2000 Winter</p>]]></description></item><item><title>Overview: Medicare Post-Acute Care Since the BalancedBudget Act of 1997</title><pubDate>Mon, 04 Nov 2019 02:28:19 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1214273</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1214273</guid><description><![CDATA[<p>page_range: 1-6</p><p>primary_author: Cotterill, Philip G.</p><p>title: Overview: Medicare Post-Acute Care Since the BalancedBudget Act of 1997</p><p>volume: 24</p><p>year_period: 2002 Winter</p>]]></description></item><item><title>Provider-and Plan-Specific Measures of Quality</title><pubDate>Mon, 04 Nov 2019 02:28:19 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1214479</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1214479</guid><description><![CDATA[<p>page_range: 1-4</p><p>primary_author: Kapp, Mary C.</p><p>title: Provider-and Plan-Specific Measures of Quality</p><p>volume: 23</p><p>year_period: 2002 Summer</p>]]></description></item><item><title>Medicare+Choice Individual and Group Enrollment: 2001and 2002</title><pubDate>Mon, 04 Nov 2019 02:28:18 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1214296</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1214296</guid><description><![CDATA[<p>page_range: 145-154</p><p>primary_author: Hileman, Geoffrey R.</p><p>title: Medicare+Choice Individual and Group Enrollment: 2001and 2002</p><p>volume: 24</p><p>year_period: 2002 Fall</p>]]></description></item><item><title>Medicaid and SCHIP Coverage: Findings from California and North Carolina</title><pubDate>Mon, 04 Nov 2019 02:28:18 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1206465</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1206465</guid><description><![CDATA[<p>page_range: 71-86</p><p>primary_author: Kenney, G.</p><p>title: Medicaid and SCHIP Coverage: Findings from California and North Carolina</p><p>volume: 29</p><p>year_period: 2007 Fall</p>]]></description></item><item><title>Medicaid and Health Information: Current and Emerging Legal Issues</title><pubDate>Mon, 04 Nov 2019 02:28:18 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1206146</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1206146</guid><description><![CDATA[<p>page_range: 21-30</p><p>primary_author: Rosenbaum, S.</p><p>title: Medicaid and Health Information: Current and Emerging Legal Issues</p><p>volume: 29</p><p>year_period: 2006 Winter</p>]]></description></item><item><title>Social and Economic Determinants of Medicare Managed Care Paricipation</title><pubDate>Mon, 04 Nov 2019 02:28:18 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1196571</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1196571</guid><description><![CDATA[<p>page_range: 1-4</p><p>primary_author: Heller, A.</p><p>title: Social and Economic Determinants of Medicare Managed Care Paricipation</p><p>volume: 26</p><p>year_period: 2005 Spring</p>]]></description></item><item><title>Voluntary Disenrollment from Medicare Managed Care:Market Factors and Disabled Beneficiaries</title><pubDate>Mon, 04 Nov 2019 02:28:18 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1196574</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1196574</guid><description><![CDATA[<p>page_range: 45-62</p><p>primary_author: Mobley, L.</p><p>title: Voluntary Disenrollment from Medicare Managed Care:Market Factors and Disabled Beneficiaries</p><p>volume: 26</p><p>year_period: 2005 Spring</p>]]></description></item><item><title>Participation and Crowd-Out in a Medicare Drug Benefit: Simulation Estimates</title><pubDate>Mon, 04 Nov 2019 02:28:18 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1214279</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1214279</guid><description><![CDATA[<p>page_range: 47-62</p><p>primary_author: Shea, Dennis</p><p>title: Participation and Crowd-Out in a Medicare Drug Benefit: Simulation Estimates</p><p>volume: 25</p><p>year_period: 2003 Winter</p>]]></description></item><item><title>Diabetes in the Medicare Aged Population, 2004</title><pubDate>Mon, 04 Nov 2019 02:28:18 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1214670</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1214670</guid><description><![CDATA[<p>page_range: 91-102</p><p>primary_author: Adler, G. S.</p><p>title: Diabetes in the Medicare Aged Population, 2004</p><p>volume: 29</p><p>year_period: 2007 Winter</p>]]></description></item><item><title>Repricing Specialty Hospital Outpatient Services Using Ambulatory Surgery Center Prices</title><pubDate>Mon, 04 Nov 2019 02:28:18 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1214669</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1214669</guid><description><![CDATA[<p>page_range: 81-90</p><p>primary_author: Healy, D.</p><p>title: Repricing Specialty Hospital Outpatient Services Using Ambulatory Surgery Center Prices</p><p>volume: 29</p><p>year_period: 2007 Winter</p>]]></description></item><item><title>High Risk Pools for Uninsurable Individuals: Recent Growth, Future Prospects</title><pubDate>Mon, 04 Nov 2019 02:28:18 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1214724</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1214724</guid><description><![CDATA[<p>page_range: 73-85</p><p>primary_author: Frakt, Austin B.</p><p>title: High Risk Pools for Uninsurable Individuals: Recent Growth, Future Prospects</p><p>volume: 26</p><p>year_period: 2004 Winter</p>]]></description></item><item><title>Estimates of Dual and Full Medicaid Benefit Dual Enrollees, 1999</title><pubDate>Mon, 04 Nov 2019 02:28:18 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1214728</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1214728</guid><description><![CDATA[<p>page_range: 133-139</p><p>primary_author: Baugh, David K.</p><p>title: Estimates of Dual and Full Medicaid Benefit Dual Enrollees, 1999</p><p>volume: 26</p><p>year_period: 2004 Winter</p>]]></description></item><item><title>Future Directions of the National Health Expenditure Accounts: Conference Overview</title><pubDate>Mon, 04 Nov 2019 02:28:18 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1205327</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1205327</guid><description><![CDATA[<p>page_range: 1-8</p><p>primary_author: Huskamp, H. A.</p><p>title: Future Directions of the National Health Expenditure Accounts: Conference Overview</p><p>volume: 28</p><p>year_period: 2006 Fall</p>]]></description></item><item><title>Medicare Beneficiary Knowledge: Measurement Implications from a Qualitative Study</title><pubDate>Mon, 04 Nov 2019 02:28:18 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1205547</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1205547</guid><description><![CDATA[<p>page_range: 13-23</p><p>primary_author: Teal, C. R.</p><p>title: Medicare Beneficiary Knowledge: Measurement Implications from a Qualitative Study</p><p>volume: 27</p><p>year_period: 2006 Summer</p>]]></description></item><item><title>Medicare and Medicaid: The Past as Prologue</title><pubDate>Mon, 04 Nov 2019 02:28:18 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1216284</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1216284</guid><description><![CDATA[<p>page_range: 81</p><p>primary_author: Berkowitz</p><p>title: Medicare and Medicaid: The Past as Prologue</p><p>volume: Volume 29</p><p>year_period: 2008 Spring</p>]]></description></item><item><title>Impacts of a Disease Management Program for Dually</title><pubDate>Mon, 04 Nov 2019 02:28:18 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1220336</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1220336</guid><description><![CDATA[<p>page_range: 27</p><p>primary_author: Esposito, D.</p><p>title: Impacts of a Disease Management Program for Dually</p><p>volume: 30</p><p>year_period: 2008 Fall</p>]]></description></item><item><title>Medicare at Forty</title><pubDate>Mon, 04 Nov 2019 02:28:18 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1200461</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1200461</guid><description><![CDATA[<p>page_range: 53-62</p><p>primary_author: Davis, K.</p><p>title: Medicare at Forty</p><p>volume: 27</p><p>year_period: 2005 Winter</p>]]></description></item><item><title>Medicare's Drug Discount Card Program: Beneficiaries' Experience with Choice</title><pubDate>Mon, 04 Nov 2019 02:28:18 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1206481</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1206481</guid><description><![CDATA[<p>page_range: 1-14</p><p>primary_author: Hassol, A.</p><p>title: Medicare's Drug Discount Card Program: Beneficiaries' Experience with Choice</p><p>volume: 28</p><p>year_period: 2007 Summer</p>]]></description></item><item><title>Variations in the use of physician services by Medicare beneficiaries.</title><pubDate>Mon, 04 Nov 2019 02:28:16 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192037</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192037</guid><description><![CDATA[<p>abstract: Variations in the utilization of physicians' services by Medicare enrollees in Michigan are examined in this article. Two measures of market-area utilization are estimated. One is the standard per capita utilization rate, which has been the common focus of many small area variation studies. The second measures the intensity with which physicians treat their patients and can be taken as an indicator of the so-called practice-style phenomenon. The results show that, although substantial intermarket variation in per capita utilization is found, the variations are not as large as one might expect and are considerably less than the variations in per capita utilization for Michigan's Blue Shield population. More important, the relationship between a market's per capita utilization and intensity of care of primary care physicians is insignificant. The relevance of these findings, especially within the context of the practice style hypothesis and policy proposals that would establish physician practice norms, are discussed.</p><p>authors: Folland, Sherman</p><p>issue_mesh: Physician's Practice Patterns : Blue Shield/utilization : Comparative Study : Data Collection : Health Services Accessibility : Insurance, Physician Services/utilization : Medicare/utilization : Michigan : Personal Health Services/utilization : Regression Analysis : Statistics : Support, U.S. Gov't, Non-P.H.S.</p><p>issue_number: 3</p><p>ntis_number: PB88-218862</p><p>page_range: 51-58</p><p>primary_author: Stano, Miron</p><p>title: Variations in the use of physician services by Medicare beneficiaries.</p><p>volume: 9</p><p>year_period: 1988 Spring</p>]]></description></item><item><title>Medicaid expenditures for the disabled under a work incentive program.</title><pubDate>Mon, 04 Nov 2019 02:28:16 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192033</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192033</guid><description><![CDATA[<p>abstract: Congress enacted Section 1619 of the Social Security Act to enable the disabled receiving Supplemental Security Income (SSI) to obtain jobs and still retain Medicaid health benefits. Congress intended this work incentive to remove the fear of the severely disabled that by obtaining employment they would lose Medicaid benefits. Based on data from 11 States, our analysis found that Medicaid expenditures for Section 1619 enrollees were relatively small and only one-half the average Medicaid expenditure for the disabled. Retaining Medicaid appears to provide a significant work incentive because Medicaid expenditures represent 13 percent of Section 1619 enrollees' earnings.</p><p>authors: Baugh, David K; Pine, Penelope L; Ruther, Martin M; Rymer, Marilyn P</p><p>issue_mesh: Disabled Persons : Employment : Health Expenditures : Data Collection : Human : Medicaid/utilization : Models, Theoretical : Motivation : Social Security/legislation &#x26; jurisprudence : Statistics : United States</p><p>issue_number: 3</p><p>ntis_number: PB88-218862</p><p>page_range: 1-8</p><p>primary_author: Andrews, Roxanne M</p><p>title: Medicaid expenditures for the disabled under a work incentive program.</p><p>volume: 9</p><p>year_period: 1988 Spring</p>]]></description></item><item><title>Medicaid hospital spending: effects of reimbursement and utilization control policies.</title><pubDate>Mon, 04 Nov 2019 02:28:16 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192029</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192029</guid><description><![CDATA[<p>abstract: Numerous Medicaid hospital spending policies were developed following the passage of the 1981 Omnibus Budget Reconciliation Act. The impact of reimbursement and utilization control policies on Medicaid hospital spending was measured using Medicaid program data for 1977-84. Medicaid prospective reimbursement was found to contain real hospital spending by controlling spending per recipient. However, sustained reductions in the growth in real Medicaid spending are achieved only when Medicaid is included in a broader regulatory framework, not when it is the sole regulated payer. Prior authorization for specific services reduces growth in hospital spending by reducing the growth in inpatient recipients.</p><p>authors: N/A</p><p>issue_mesh: Acute Disease/economics : Data Collection : Health Expenditures/trends : Hospitalization/economics : Medicaid/utilization : Regression Analysis : Statistics : Support, U.S. Gov't, Non-P.H.S. : United States</p><p>issue_number: 2</p><p>ntis_number: PB88-196670</p><p>page_range: 65-77</p><p>primary_author: Zuckerman, Stephen</p><p>title: Medicaid hospital spending: effects of reimbursement and utilization control policies.</p><p>volume: 9</p><p>year_period: 1987 Winter</p>]]></description></item><item><title>Effects of selected fee schedule options on physicians' Medicare receipts.</title><pubDate>Mon, 04 Nov 2019 02:28:15 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192027</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192027</guid><description><![CDATA[<p>abstract: The Congress has indicated interest in modifying the system by which Medicare pays for physicians' services, and implementation of a Medicare fee schedule may be the most feasible change in the near term. In this article, the effects on physicians' Medicare receipts of a variety of fee schedules are simulated using 1984 Medicare claims data for a nationally representative sample of physician practices. The results show that reasonable choices concerning specialty and geographic differentials would shift payments away from surgical specialists and urban areas toward generalists (general practitioners, family practitioners, and internists) and less urban areas.</p><p>authors: N/A</p><p>issue_mesh: Data Collection : Fee Schedules/methods : Insurance, Physician Services/economics : Medicare/economics : Specialties, Medical/economics : Statistics : United States</p><p>issue_number: 2</p><p>ntis_number: PB88-196670</p><p>page_range: 25-37</p><p>primary_author: Christensen, Sandra</p><p>title: Effects of selected fee schedule options on physicians' Medicare receipts.</p><p>volume: 9</p><p>year_period: 1987 Winter</p>]]></description></item><item><title>Hospital utilization and expenditures for Medicaid enrollees by major diagnosis group.</title><pubDate>Mon, 04 Nov 2019 02:28:15 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192023</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192023</guid><description><![CDATA[<p>abstract: The distribution of Medicaid hospital discharges and expenditures by major diagnosis group for Medicaid enrollees in California, Michigan, and New York during 1982 are examined in this article. Although hospital expenditures represent a major component of Medicaid expenditures, the extent of variation in Medicaid inpatient utilization and expenditures across diagnoses and between States has not been previously studied. In this article, Medicaid inpatient hospital utilization and expenditure data by major diagnosis group from the Health Care Financing Administration's Tape-to-Tape data base are examined to determine whether significant interstate differences exist.</p><p>authors: Buczko, William; Howell, Embry M</p><p>issue_mesh: Aid to Families with Dependent Children/utilization : California : Data Collection : Diagnosis-Related Groups : Health Expenditures/trends : Hospitals/utilization : Medicaid/utilization : Michigan : New York : Statistics</p><p>issue_number: 1</p><p>ntis_number: PB88-160221</p><p>page_range: 91-96</p><p>primary_author: Pine, Penelope L</p><p>title: Hospital utilization and expenditures for Medicaid enrollees by major diagnosis group.</p><p>volume: 9</p><p>year_period: 1987 Fall</p>]]></description></item><item><title>Nursing dependency, diagnosis-related groups, and length of hospital stay.</title><pubDate>Mon, 04 Nov 2019 02:28:15 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191995</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191995</guid><description><![CDATA[<p>abstract: Most efforts to modify the diagnosis-related group (DRG) case classification system focus on variables related to medical management. In this study, we investigated the separate but related natures of medicine and nursing by examining 1,288 adult medical and surgical patients in an urban teaching hospital. The complexity of medical treatment was measured by use of the DRG relative cost weight. The nursing indicator was derived from a set of nursing diagnoses. We found that the DRG cost weight is a poor predictor of nursing dependency and that the nursing dependence index added significantly to the DRG weight in explaining length of stay.</p><p>authors: Kiley, Marylou</p><p>issue_mesh: Diagnosis-Related Groups : Length of Stay : Nursing Assessment : Data Collection : Evaluation Studies : Hospital Bed Capacity, 500 and over : Nursing Service, Hospital/classification : Ohio : Statistics</p><p>issue_number: 3</p><p>ntis_number: PB88-131578</p><p>page_range: 27-36</p><p>primary_author: Halloran, Edward J</p><p>title: Nursing dependency, diagnosis-related groups, and length of hospital stay.</p><p>volume: 8</p><p>year_period: 1987 Spring</p>]]></description></item><item><title>Urban and rural hospitals: how do they differ?</title><pubDate>Mon, 04 Nov 2019 02:28:15 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191992</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191992</guid><description><![CDATA[<p>abstract: When the Health Care Financing Administration implemented the Medicare prospective payment system (PPS), the payment rates for inpatient hospital operating costs were derived on an urban and rural basis within each region. The rates were also adjusted for area wage levels and other factors affecting hospital costs. The effect of PPS on rural hospitals is of widespread interest. This article provides data on rural and urban hospital facilities, utilization, and charges, as of April 1985. Almost 48 percent of the 5,821 short stay hospitals included in the PPS recalibration file for Federal fiscal year 1984 are located in rural areas. Rural and urban areas are designated by the Executive Office of Management and Budget or, in some instances by regulation.</p><p>authors: Connerton, Rose E</p><p>issue_mesh: Prospective Payment System : Ancillary Services, Hospital/economics : Comparative Study : Data Collection : Fees and Charges : Hospitals, Rural/utilization : Hospitals, Urban/utilization : Hospitals/utilization : Medicare/economics : Statistics : United States</p><p>issue_number: 2</p><p>ntis_number: PB88-131586</p><p>page_range: 77-85</p><p>primary_author: Hatten, James M</p><p>title: Urban and rural hospitals: how do they differ?</p><p>volume: 8</p><p>year_period: 1986 Winter</p>]]></description></item><item><title>The need for special interventions for multiple hospital admission patients.</title><pubDate>Mon, 04 Nov 2019 02:28:15 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192057</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192057</guid><description><![CDATA[<p>ntis_number: PB89-188494</p><p>page_range: 57-67</p><p>primary_author: Eggert, Gerald M</p><p>title: The need for special interventions for multiple hospital admission patients.</p><p>volume: Supp.</p><p>year_period: 1988 Supp.</p>]]></description></item><item><title>Trends in Medicare use of post-hospital care.</title><pubDate>Mon, 04 Nov 2019 02:28:15 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192054</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192054</guid><description><![CDATA[<p>ntis_number: PB89-188494</p><p>page_range: 27-38</p><p>primary_author: Gornick, Marian</p><p>title: Trends in Medicare use of post-hospital care.</p><p>volume: Supp.</p><p>year_period: 1988 Supp.</p>]]></description></item><item><title>Case mix and charges for inpatient and outpatient chemotherapy.</title><pubDate>Mon, 04 Nov 2019 02:28:15 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192004</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192004</guid><description><![CDATA[<p>abstract: Case mix and charges for chemotherapy treatment were examined by an analysis of the inpatient discharges for DRG 410 (chemotherapy) from eight teaching hospitals and of outpatient visits from two teaching hospitals. Discharges for ovarian cancer were the most common and the least expensive, costing $1,600 or half as much as the most costly, less common conditions (leukemia and testicle cancer). Diagnosis explained 13 percent of the inpatient charge variation; metastasis explained less than 1 percent. Outpatient chemotherapy overlapped with inpatient among only 3 of the 10 most common diagnoses. The implication is that the two settings are complementary with regard to chemotherapy administration.</p><p>authors: Bergman, Andrew; Come, Steven; Henderson, Mary G; Malbon, Alan</p><p>issue_mesh: Ambulatory Care : Boston : Diagnosis-Related Groups/economics : Fees and Charges : Hospitals, Teaching/economics : Human : Neoplasms/classification/drug therapy : Patient Admission : Statistics : Support, U.S. Gov't, Non-P.H.S.</p><p>issue_number: 4</p><p>ntis_number: PB88-131339</p><p>page_range: 65-71</p><p>primary_author: Lion, Joanna</p><p>title: Case mix and charges for inpatient and outpatient chemotherapy.</p><p>volume: 8</p><p>year_period: 1987 Summer</p>]]></description></item><item><title>Policy issues related to prospective payment for pediatric hospitalization.</title><pubDate>Mon, 04 Nov 2019 02:28:15 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192021</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192021</guid><description><![CDATA[<p>abstract: Children's hospitals have been excluded from the Medicare prospective payment system (PPS) because of concerns over the applicability of the DRG case-mix system and PPS payment weights to pediatric hospitalization. Nevertheless, DRG-based payment systems are being adopted by State Medicaid agencies and private third-party payers, and the Health Care Financing Administration has been mandated to report to Congress on the feasibility of including children's hospitals in the Federal PPS. This article summarizes policy research on this issue and discusses options in the design of prospective payment systems for pediatric hospitalization.</p><p>authors: Restuccia, Joseph D</p><p>issue_mesh: Adolescence : Age Factors : Child : Child, Preschool : Diagnosis-Related Groups/classification : Hospitals, Pediatric/economics : Hospitals, Special/economics : Human : Infant : Infant, Newborn : Medicaid : Medicare : Patient Transfer : Prospective Payment System/methods : Support, U.S. Gov't, Non-P.H.S. : United States</p><p>issue_number: 1</p><p>ntis_number: PB88-160221</p><p>page_range: 71-82</p><p>primary_author: Payne, Susan M</p><p>title: Policy issues related to prospective payment for pediatric hospitalization.</p><p>volume: 9</p><p>year_period: 1987 Fall</p>]]></description></item><item><title>National health expenditures, 1986-2000.</title><pubDate>Mon, 04 Nov 2019 02:28:15 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192001</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192001</guid><description><![CDATA[<p>abstract: Patterns of spending for health during 1986 and beyond reflect a mixture of adherence to and change from historical trends. From a level of $458 billion in 1986--10.9 percent of the GNP--national health expenditures are projected to reach $1.5 trillion by the year 2000--15.0 percent of the GNP. This article presents a provisional estimate of spending in 1986 and projections of spending (under the assumption of current law) through the year 2000. Also discussed are the effects of the demographic composition of the population on spending for health, and how spending would increase in the future simply as a result of the evolution of that composition.</p><p>authors: N/A</p><p>issue_mesh: Forecasting : Age Factors : Economics/trends : Fees and Charges/trends : Health Expenditures/trends : Hospitals, Community/utilization : Medicare : Models, Theoretical : Sex Factors : Statistics : United States</p><p>issue_number: 4</p><p>ntis_number: PB88-131339</p><p>page_range: 1-36</p><p>primary_author: N/A, N/A</p><p>title: National health expenditures, 1986-2000.</p><p>volume: 8</p><p>year_period: 1987 Summer</p>]]></description></item><item><title>End-stage renal disease: a profile of facilities furnishing treatment.</title><pubDate>Mon, 04 Nov 2019 02:28:13 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191897</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191897</guid><description><![CDATA[<p>authors: McMullan, Michael</p><p>issue_mesh: Ambulatory Care Facilities/supply &#x26; distribution : Data Collection : Hemodialysis Units, Hospital/supply &#x26; distribution : Human : Kidney Failure, Chronic/economics/therapy : Medicare : United States</p><p>issue_number: 2</p><p>ntis_number: PB85-155075</p><p>page_range: 87-90</p><p>primary_author: Gibson, David A</p><p>title: End-stage renal disease: a profile of facilities furnishing treatment.</p><p>volume: 6</p><p>year_period: 1984 Winter</p>]]></description></item><item><title>Return to nursing home investment: issues for public policy.</title><pubDate>Mon, 04 Nov 2019 02:28:13 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191872</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191872</guid><description><![CDATA[<p>abstract: Because Government policy does much to determine the return available to nursing home investment, the profitability of the nursing home industry has been a subject of controversy since Government agencies began paying a large portion of the Nation's nursing home bill. Controversy appears at several levels. First is the rather narrow concern, often conceived in accounting terms, of the appropriate reimbursement of capital-related expense under Medicaid and Medicare. Second is the concern about how return to capital affects the flow of investment into nursing homes, leading either to inadequate access to care or to over-capacity. Third is the concern about how sources of return to nursing home investment affect the pattern of nursing home ownership and the amount of equity held by owners since the pattern of ownership and amount of equity have been linked to quality of care.</p><p>authors: Bishop, Christine E</p><p>issue_mesh: Public Policy : Reimbursement Mechanisms : Capital Financing : Investments/trends : Nursing Homes/economics : Ownership/economics : Support, U.S. Gov't, P.H.S. : United States</p><p>issue_number: 4</p><p>ntis_number: PB84-229343</p><p>page_range: 43-52</p><p>primary_author: Baldwin, Carliss Y</p><p>title: Return to nursing home investment: issues for public policy.</p><p>volume: 5</p><p>year_period: 1984 Summer</p>]]></description></item><item><title>An analysis of structural incentives in the Arizona Health Care Cost-Containment System.</title><pubDate>Mon, 04 Nov 2019 02:28:13 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191869</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191869</guid><description><![CDATA[<p>abstract: This article analyzes the financial structures of the prevailing public and private health insurance mechanisms. Based on this analysis, it was concluded that the financial structures of health insurance mechanisms are deficient in that they neither produce efficiency in the consumption of health services, nor generate efficiency in the production of health services. On the other hand, closed-end systems of finance, such as the health maintenance organization (HMO) or the new Arizona Health Care Cost-Containment System (AHCCCS), give more promise of achieving such efficiencies. The AHCCCS represents an important innovation in the public financing of health care, and, for policy purposes, should be considered a viable national alternative for the reform of Medicare and Medicaid.</p><p>authors: N/A</p><p>issue_mesh: Medical Indigency : Reimbursement Mechanisms : Reimbursement, Incentive : Arizona : Cost Control/methods : Medicaid/organization &#x26; administration : Models, Theoretical</p><p>issue_number: 4</p><p>ntis_number: PB84-229343</p><p>page_range: 13-22</p><p>primary_author: Vogel, Ronald J</p><p>title: An analysis of structural incentives in the Arizona Health Care Cost-Containment System.</p><p>volume: 5</p><p>year_period: 1984 Summer</p>]]></description></item><item><title>The use and costs of Medicare services in the last 2 years of life.</title><pubDate>Mon, 04 Nov 2019 02:28:13 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191865</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191865</guid><description><![CDATA[<p>abstract: This study reports on the use of services by Medicare enrollees who died in 1978. Decedents comprised 5.9 percent of the study group but accounted for 28 percent of Medicare expenditures. The use of services became more intense as death approached. Despite the idea that heroic efforts to prolong life are common, only 6 percent of persons who died had more than $15,000 in Medicare expenses in their last year of life. As shown here, the unique patterns of health care use by decedents and survivors should be fully understood and considered when contemplating changes in the Medicare program.</p><p>authors: Prihoda, Ronald</p><p>issue_mesh: Aged : Costs and Cost Analysis : Human : Medicare/utilization : Statistics : Terminal Care/economics : United States</p><p>issue_number: 3</p><p>ntis_number: PB84-189844</p><p>page_range: 117-131</p><p>primary_author: Lubitz, James</p><p>title: The use and costs of Medicare services in the last 2 years of life.</p><p>volume: 5</p><p>year_period: 1984 Spring</p>]]></description></item><item><title>Classifying severity of illness by using clinical findings.</title><pubDate>Mon, 04 Nov 2019 02:28:13 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191884</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191884</guid><description><![CDATA[<p>ntis_number: PB85-155083</p><p>page_range: 107-108</p><p>primary_author: Brewster, Alan G</p><p>title: Classifying severity of illness by using clinical findings.</p><p>volume: Supp.</p><p>year_period: 1984 Supp.</p>]]></description></item><item><title>Home health care cost-function analysis.</title><pubDate>Mon, 04 Nov 2019 02:28:13 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191864</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191864</guid><description><![CDATA[<p>abstract: An exploratory home health care (HHC) cost-function model is estimated using State rate-setting data for the 74 traditional (nonprofit) Connecticut agencies. The analysis demonstrates U-shaped average costs curves for agencies' provision of skilled nursing visits, with substantial diseconomies of scale in the observable range. It is determined from the estimated cost function that the sample representative agency is providing fewer visits than optimal, and its marginal cost is significantly below average cost. The finding that an agency's costs are predominantly related to output levels, with little systematic variation due to other agency or patient characteristics, suggests that the economic inefficiency in a cost-based HHC reimbursement policy may be substantial.</p><p>authors: Mandes, George</p><p>issue_mesh: Analysis of Variance : Connecticut : Cost-Benefit Analysis : Home Care Services/economics : Models, Theoretical</p><p>issue_number: 3</p><p>ntis_number: PB84-189844</p><p>page_range: 111-116</p><p>primary_author: Hay, Joel W</p><p>title: Home health care cost-function analysis.</p><p>volume: 5</p><p>year_period: 1984 Spring</p>]]></description></item><item><title>Medicare prospective payment system: Length of stay for selected diagnosis-related groups.</title><pubDate>Mon, 04 Nov 2019 02:28:13 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191960</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191960</guid><description><![CDATA[<p>authors: Lawrence, Tim</p><p>issue_mesh: Length of Stay/statistics &#x26; numerical data/trends : Diagnosis-Related Groups/classification : Medicare : Prospective Payment System : United States</p><p>issue_number: 4</p><p>ntis_number: PB86-241262</p><p>page_range: 99-106</p><p>primary_author: Callahan, Wayne</p><p>title: Medicare prospective payment system: Length of stay for selected diagnosis-related groups.</p><p>volume: 7</p><p>year_period: 1986 Summer</p>]]></description></item><item><title>End-of-Life Expenditures by Ohio Medicaid Beneficiaries Dying of Cancer</title><pubDate>Mon, 04 Nov 2019 02:28:12 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1214490</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1214490</guid><description><![CDATA[<p>page_range: 65-80</p><p>primary_author: Koroukian, S. M.</p><p>title: End-of-Life Expenditures by Ohio Medicaid Beneficiaries Dying of Cancer</p><p>volume: 28</p><p>year_period: 2006 Winter</p>]]></description></item><item><title>A distributional assessment of Rhode Island's Catastrophic Health Insurance Plan (CHIP).</title><pubDate>Mon, 04 Nov 2019 02:28:12 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191888</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191888</guid><description><![CDATA[<p>abstract: Since 1975, Rhode Island has operated a government-sponsored catastrophic health insurance program that is consistent in spirit with several of the national health insurance proposals. An important but often overlooked effect of such a program is its effect on the distribution of income. Actual claims data for the years 1975-79 are available for the Rhode Island program permitting direct estimation of an average benefit per family and an average tax burden per family in each of 12 income classes. This permits an assessment of the program's redistributional effects.</p><p>authors: N/A</p><p>issue_mesh: Income : Cost Allocation : Insurance Benefits/economics : Insurance, Major Medical/legislation &#x26; jurisprudence : Rhode Island</p><p>issue_number: 1</p><p>ntis_number: PB85-124188</p><p>page_range: 51-59</p><p>primary_author: Lord, Blair M</p><p>title: A distributional assessment of Rhode Island's Catastrophic Health Insurance Plan (CHIP).</p><p>volume: 6</p><p>year_period: 1984 Fall</p>]]></description></item><item><title>Medicare expenditures and utilization under State hospital rate setting.</title><pubDate>Mon, 04 Nov 2019 02:28:12 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191935</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191935</guid><description><![CDATA[<p>abstract: In this study we analyzed the National Hospital Rate-Setting Study findings concerning the effects of State prospective reimbursement (PR) programs on Medicare expenditures and utilization; we used Medicare beneficiary-based data complied from a sample of approximately 1,300 counties in States with and without rate-setting programs for the 5-year period 1974-78. The statistical evidence suggests that stringent PR programs have not resulted in hospitals using Medicare to cross-subsidize losses elsewhere. In addition, it appears that Medicare has been a passive recipient of the same kinds of regulatory benefits accruing to PR-covered patients (i.e., costs and intensity of care have been constrained).</p><p>authors: Hewes, Helene T</p><p>issue_mesh: Government : State Government : Economics, Hospital/trends : Fees and Charges : Medicare/economics : Models, Theoretical : Prospective Payment System/economics : Reimbursement Mechanisms/economics : Statistics : United States</p><p>issue_number: 1</p><p>ntis_number: PB86-156759</p><p>page_range: 97-109</p><p>primary_author: Cromwell, Jerry L</p><p>title: Medicare expenditures and utilization under State hospital rate setting.</p><p>volume: 7</p><p>year_period: 1985 Fall</p>]]></description></item><item><title>Containing Medicaid costs in an era of growing physician supply.</title><pubDate>Mon, 04 Nov 2019 02:28:12 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191932</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191932</guid><description><![CDATA[<p>abstract: In this analysis, Medicaid cost containment is viewed within the theoretical framework of a price discrimination model. The value of viewing supply decisions made by physicians in terms of the conventional economic laws of supply and demand is demonstrated. Physicians are seen to respond to prices in a predictable way. As private prices increase, physicians are less willing to participate in Medicaid. As Medicaid prices increase, physicians are more willing to participate. Effects of changes in the number of persons eligible for Medicaid and in the physician supply are also analyzed.</p><p>authors: Holahan, John</p><p>issue_mesh: Cost Control : Fees, Medical : Health Services Needs and Demand : Medicaid/economics : Models, Theoretical : Physicians/supply &#x26; distribution : United States</p><p>issue_number: 1</p><p>ntis_number: PB86-156759</p><p>page_range: 49-60</p><p>primary_author: Held, Philip J</p><p>title: Containing Medicaid costs in an era of growing physician supply.</p><p>volume: 7</p><p>year_period: 1985 Fall</p>]]></description></item><item><title>The relationship of hospital ownership and service composition to hospital charges.</title><pubDate>Mon, 04 Nov 2019 02:28:12 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191902</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191902</guid><description><![CDATA[<p>abstract: The relationship of hospital ownership and service composition to hospital charges was examined for 456 general acute hospitals in California. Ancillary services had higher profit margins, both gross and net profits, than daily hospital services. Ancillary services accounted for 55.3 percent of total patient revenue. Charges per day were 23 percent higher for ancillary services than for daily hospital services. Net profits for daily and ancillary services were lowest at county hospitals. Proprietary hospitals had the highest net profits for total ancillary services and the highest mean charges. Not-for-profit hospitals had the highest profit margins for daily hospital services. Neither direct nor total costs for ancillary services were significantly different among ownership groups, although direct costs for daily hospital services were significantly higher at proprietary hospitals.</p><p>authors: Peddecord, K Michael</p><p>issue_mesh: Economics, Hospital : Fees and Charges : Analysis of Variance : Ancillary Services, Hospital/economics : California : Costs and Cost Analysis : Direct Service Costs : Income : Ownership/economics</p><p>issue_number: 3</p><p>ntis_number: PB85-226165</p><p>page_range: 51-58</p><p>primary_author: Eskoz, Robin</p><p>title: The relationship of hospital ownership and service composition to hospital charges.</p><p>volume: 6</p><p>year_period: 1985 Spring</p>]]></description></item><item><title>National health expenditures, 1985.</title><pubDate>Mon, 04 Nov 2019 02:28:10 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191977</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191977</guid><description><![CDATA[<p>abstract: Slower price inflation in 1985 translated into slower growth of national health expenditures, but underlying growth in the use of goods and services continued along historic trends. Coupled with somewhat sluggish growth of the gross national product, this adherence to trends pushed the share of our Nation's output accounted for by health spending to 10.7 percent. Some aspects of health spending changed: falling use of hospital services was offset by rising hospital profits and increased use of other health care services. Other aspects remained the same: both the public sector and the private sector continued efforts to contain costs, efforts that have affected and will continue to affect not only the providers of care but the users of care as well.</p><p>authors: Lazenby, Helen C; Levit, Katharine R</p><p>issue_mesh: Data Collection : Economics, Medical/trends : Financing, Organized/trends : Health Expenditures/trends : Inflation, Economic : Statistics : United States</p><p>issue_number: 1</p><p>ntis_number: PB88-131545</p><p>page_range: 1-22</p><p>primary_author: Waldo, Daniel R</p><p>title: National health expenditures, 1985.</p><p>volume: 8</p><p>year_period: 1986 Fall</p>]]></description></item><item><title>A comparison of hospital outpatient departments and private practice.</title><pubDate>Mon, 04 Nov 2019 02:28:10 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191908</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191908</guid><description><![CDATA[<p>abstract: This article addresses cost differences between primary care physicians in private practice and hospital outpatient departments (OPD's). The analysis utilizes ambulatory visit groups (AVG's), the outpatient equivalent of diagnosis-related groups (DRG's), to adjust for case mix. Major findings are that OPD's have higher per visit costs than physicians' private offices; internists are more expensive than general practitioners regardless of site; and ancillary service costs are actually slightly higher in private practice. Any prospective payment system for ambulatory care must consider these costs differences.</p><p>authors: Friedman, Robert H; Henderson, Mary G; Malbon, Alan</p><p>issue_mesh: Comparative Study : Costs and Cost Analysis : Diagnosis-Related Groups/economics : Outpatient Clinics, Hospital/economics : Primary Health Care/economics : Private Practice/economics : Support, Non-U.S. Gov't : Support, U.S. Gov't, Non-P.H.S. : United States</p><p>issue_number: 4</p><p>ntis_number: PB86-139409</p><p>page_range: 69-81</p><p>primary_author: Lion, Joanna</p><p>title: A comparison of hospital outpatient departments and private practice.</p><p>volume: 6</p><p>year_period: 1985 Summer</p>]]></description></item><item><title>Variation in Patient Reported Quality Among Health Care Organizations</title><pubDate>Mon, 04 Nov 2019 02:28:10 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1214481</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1214481</guid><description><![CDATA[<p>page_range: 85-100</p><p>primary_author: Solomon, Loel S.</p><p>title: Variation in Patient Reported Quality Among Health Care Organizations</p><p>volume: 23</p><p>year_period: 2002 Summer</p>]]></description></item><item><title>Quality Improvement in a Primary Care Case Management Program</title><pubDate>Mon, 04 Nov 2019 02:28:10 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1214480</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1214480</guid><description><![CDATA[<p>page_range: 71-84</p><p>primary_author: Walsh, Edith G.</p><p>title: Quality Improvement in a Primary Care Case Management Program</p><p>volume: 23</p><p>year_period: 2002 Summer</p>]]></description></item><item><title>Combining HEDIS Indicators: A New Approach to Measuring Plan Performance</title><pubDate>Mon, 04 Nov 2019 02:28:10 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1214487</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1214487</guid><description><![CDATA[<p>page_range: 117-130</p><p>primary_author: Lied, Terry R.</p><p>title: Combining HEDIS Indicators: A New Approach to Measuring Plan Performance</p><p>volume: 23</p><p>year_period: 2002 Summer</p>]]></description></item><item><title>Future Financial Viability of Rural Hospitals</title><pubDate>Mon, 04 Nov 2019 02:28:10 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1214484</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1214484</guid><description><![CDATA[<p>page_range: 175-188</p><p>primary_author: Stensland, Jeffrey</p><p>title: Future Financial Viability of Rural Hospitals</p><p>volume: 23</p><p>year_period: 2002 Summer</p>]]></description></item><item><title>Screening for Osteoporosis and Colon Cancer Under Medicare</title><pubDate>Mon, 04 Nov 2019 02:28:10 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1214486</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1214486</guid><description><![CDATA[<p>page_range: 189-200</p><p>primary_author: Adler, Gerald S.</p><p>title: Screening for Osteoporosis and Colon Cancer Under Medicare</p><p>volume: 23</p><p>year_period: 2002 Summer</p>]]></description></item><item><title>Key Milestones in Medicare and Medicaid History, Selected Years: 1965-2003</title><pubDate>Mon, 04 Nov 2019 02:28:10 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1198591</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1198591</guid><description><![CDATA[<p>title: Key Milestones in Medicare and Medicaid History, Selected Years: 1965-2003</p><p>volume: 27</p><p>year_period: 2005 Winter</p>]]></description></item><item><title>Consequences of States' Policies for SCHIP Disenrollment</title><pubDate>Mon, 04 Nov 2019 02:28:10 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1214478</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1214478</guid><description><![CDATA[<p>page_range: 65-88</p><p>primary_author: Dick, Andrew W.</p><p>title: Consequences of States' Policies for SCHIP Disenrollment</p><p>volume: 23</p><p>year_period: 2002 Spring</p>]]></description></item><item><title>PRO DEM: A Community-Based Approach to Care for Dementia</title><pubDate>Mon, 04 Nov 2019 02:28:10 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1214269</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1214269</guid><description><![CDATA[<p>page_range: 89-94</p><p>primary_author: Hesse, E.</p><p>title: PRO DEM: A Community-Based Approach to Care for Dementia</p><p>volume: 27</p><p>year_period: 2005 Fall</p>]]></description></item><item><title>Improved Estimates of Capital formation in the National Health expenditure Accounts</title><pubDate>Mon, 04 Nov 2019 02:28:10 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1205329</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1205329</guid><description><![CDATA[<p>page_range: 9-23</p><p>primary_author: Sensening, A. L.</p><p>title: Improved Estimates of Capital formation in the National Health expenditure Accounts</p><p>volume: 28</p><p>year_period: 2006 Fall</p>]]></description></item><item><title>Determinants of physician assignment rates by type of service.</title><pubDate>Mon, 04 Nov 2019 02:28:10 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191871</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191871</guid><description><![CDATA[<p>abstract: In this article, the determinants of physician assignment rates under the Medicare program are examined separately for medical, surgical, laboratory, and radiology services. Data for this study include copies of all Medicare claims submitted by over 1,200 Colorado general practitioners, internists, and general surgeons during the periods both before and after they experienced a substantial change in program reimbursement rates. The results indicate that there is a significant positive relationship between changes in reimbursement and changes in assignment rates for medical, laboratory, and radiology services, but the relationship for surgical service is not significant. Furthermore, for laboratory and radiology services, only the change in medical service reimbursement is significant--reimbursement rates for laboratory and radiology services are not.</p><p>authors: N/A</p><p>issue_mesh: Rate Setting and Review : Reimbursement Mechanisms : Colorado : Comparative Study : Medicare/utilization : Regression Analysis : Specialties, Medical/economics : Support, U.S. Gov't, P.H.S.</p><p>issue_number: 4</p><p>ntis_number: PB84-229343</p><p>page_range: 33-42</p><p>primary_author: Rice, Thomas</p><p>title: Determinants of physician assignment rates by type of service.</p><p>volume: 5</p><p>year_period: 1984 Summer</p>]]></description></item><item><title>Managed competition in health care and the unfinished agenda.</title><pubDate>Mon, 04 Nov 2019 02:28:10 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191976</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191976</guid><description><![CDATA[<p>ntis_number: PB88-131552</p><p>page_range: 105-119</p><p>primary_author: Enthoven, Alain C</p><p>title: Managed competition in health care and the unfinished agenda.</p><p>volume: Supp.</p><p>year_period: 1986 Supp.</p>]]></description></item><item><title>Physician Involvement in Disease Management as Part of the CCM</title><pubDate>Mon, 04 Nov 2019 02:28:09 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1198455</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1198455</guid><description><![CDATA[<p>page_range: 19-32</p><p>primary_author: Wallace, P. J.</p><p>title: Physician Involvement in Disease Management as Part of the CCM</p><p>volume: 27</p><p>year_period: 2005 Fall</p>]]></description></item><item><title>Dually Eligible Medicare Beneficiaries</title><pubDate>Mon, 04 Nov 2019 02:28:09 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1214448</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1214448</guid><description><![CDATA[<p>page_range: 131-140</p><p>primary_author: Lauren A. Murray</p><p>title: Dually Eligible Medicare Beneficiaries</p><p>volume: 20</p><p>year_period: 1998 Winter</p>]]></description></item><item><title>Case Study of American Healthways Diabetes DiseaseManagement Program</title><pubDate>Mon, 04 Nov 2019 02:28:09 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1198471</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1198471</guid><description><![CDATA[<p>page_range: 47-58</p><p>primary_author: Pope, J. E.</p><p>title: Case Study of American Healthways Diabetes DiseaseManagement Program</p><p>volume: 27</p><p>year_period: 2005 Fall</p>]]></description></item><item><title>Ryan White CARE Act and Eligible Metropolitan Areas</title><pubDate>Mon, 04 Nov 2019 02:28:09 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1214323</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1214323</guid><description><![CDATA[<p>page_range: 149-157</p><p>primary_author: Buchanan, Robert J.</p><p>title: Ryan White CARE Act and Eligible Metropolitan Areas</p><p>volume: 23</p><p>year_period: 2002 Summer</p>]]></description></item><item><title>HCFA's racial and ethnic data: Current accuracy and recent improvements</title><pubDate>Mon, 04 Nov 2019 02:28:09 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1190245</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1190245</guid><description><![CDATA[<p>page_range: 117-127</p><p>primary_author: Arday, Susan L</p><p>title: HCFA's racial and ethnic data: Current accuracy and recent improvements</p><p>volume: 21</p><p>year_period: 2000 Summer</p>]]></description></item><item><title>Medicaid at Forty</title><pubDate>Mon, 04 Nov 2019 02:28:09 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1200469</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1200469</guid><description><![CDATA[<p>page_range: 63-78</p><p>primary_author: Rowland, D.</p><p>title: Medicaid at Forty</p><p>volume: 27</p><p>year_period: 2005 Winter</p>]]></description></item><item><title>Care Management in Germany and the U.S.: An Expanded Laboratory</title><pubDate>Mon, 04 Nov 2019 02:28:09 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1198450</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1198450</guid><description><![CDATA[<p>page_range: 9-18</p><p>primary_author: Pittman, P. M.</p><p>title: Care Management in Germany and the U.S.: An Expanded Laboratory</p><p>volume: 27</p><p>year_period: 2005 Fall</p>]]></description></item><item><title>Quality in Medicare from Measurement to Payment and Provider to Patient</title><pubDate>Mon, 04 Nov 2019 02:28:09 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1201905</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1201905</guid><description><![CDATA[<p>title: Quality in Medicare from Measurement to Payment and Provider to Patient</p><p>volume: 27</p><p>year_period: 2005 Winter</p>]]></description></item><item><title>Fee-for-Service Medicare and Medicaid History, Selected Years</title><pubDate>Mon, 04 Nov 2019 02:28:09 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1204445</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1204445</guid><description><![CDATA[<p>page_range: 113-126</p><p>primary_author: Dowd, B. E.</p><p>title: Fee-for-Service Medicare and Medicaid History, Selected Years</p><p>volume: 27</p><p>year_period: 2005 Winter</p>]]></description></item><item><title>First German Disease Management Program for Breast</title><pubDate>Mon, 04 Nov 2019 02:28:09 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1204469</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1204469</guid><description><![CDATA[<p>page_range: 69-77</p><p>primary_author: Rupprecht, C.</p><p>title: First German Disease Management Program for Breast</p><p>volume: 27</p><p>year_period: 2005 Fall</p>]]></description></item><item><title>Managing Chronic Conditions for Elderly Adults: The VNSCHOICE Model</title><pubDate>Mon, 04 Nov 2019 02:28:09 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1198469</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1198469</guid><description><![CDATA[<p>page_range: 33-46</p><p>primary_author: Fisher, H. M.</p><p>title: Managing Chronic Conditions for Elderly Adults: The VNSCHOICE Model</p><p>volume: 27</p><p>year_period: 2005 Fall</p>]]></description></item><item><title>Risk Adjustment of Medicare Capitation Payments Using the CMS-HCC Model</title><pubDate>Mon, 04 Nov 2019 02:28:09 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191786</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191786</guid><description><![CDATA[<p>page_range: 119-141</p><p>primary_author: Pope, Gregory</p><p>title: Risk Adjustment of Medicare Capitation Payments Using the CMS-HCC Model</p><p>volume: 25</p><p>year_period: 2004 Summer</p>]]></description></item><item><title>Dental care demand: age-specific estimates for the population 65 years of age and over.</title><pubDate>Mon, 04 Nov 2019 02:28:09 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191839</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191839</guid><description><![CDATA[<p>abstract: This paper derives estimates of the demand for dental care among the U.S. population 65 years of age and over. The analysis is unique in that it focuses on a segment of the population with particular relevance to future policy regarding dental insurance coverage and distinguishes determinants of dental care demand by type of service. The empirical estimates suggest that the use of dental service by elderly persons does respond to price changes and that price-elasticity of demand varies significantly among different dental procedures.</p><p>authors: N/A</p><p>issue_mesh: Health Services Needs and Demand : Health Services Research : Aged : Dental Care/utilization : Fees, Dental : Human : Insurance, Dental/utilization : Statistics : United States</p><p>issue_number: 4</p><p>ntis_number: PB83-220657</p><p>page_range: 47-57</p><p>primary_author: Conrad, Douglas A</p><p>title: Dental care demand: age-specific estimates for the population 65 years of age and over.</p><p>volume: 4</p><p>year_period: 1983 Summer</p>]]></description></item><item><title>Health Expenditures for Medicare Beneficiaries</title><pubDate>Mon, 04 Nov 2019 02:28:09 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1214444</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1214444</guid><description><![CDATA[<p>page_range: 281-286</p><p>primary_author: Murray, Lauren A.</p><p>title: Health Expenditures for Medicare Beneficiaries</p><p>volume: 21</p><p>year_period: 1999 Winter</p>]]></description></item><item><title>Enrollment in and disenrollment from health maintenance organizations by Medicaid recipients.</title><pubDate>Mon, 04 Nov 2019 02:28:09 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191901</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191901</guid><description><![CDATA[<p>abstract: In 1977-78 Medicaid recipients in Wayne County, Michigan had the option of joining health maintenance organizations (HMO's). This article presents an analysis of utilization levels and physician contact patterns prior to HMO enrollment and following HMO disenrollment. Medicaid families that had patterns of previous contacts with non-HMO physicians overwhelmingly choose the non-HMO option. Families with no physician contacts and very low utilization levels selected the HMO's. Also, higher than average utilization occurred during the 3 months following disenrollment from these HMO's.</p><p>authors: N/A</p><p>issue_mesh: Physician-Patient Relations : Analysis of Variance : Data Collection : Health Maintenance Organizations/utilization : Human : Medicaid/utilization : Michigan : Regression Analysis</p><p>issue_number: 3</p><p>ntis_number: PB85-226165</p><p>page_range: 39-50</p><p>primary_author: DesHarnais, Susan I</p><p>title: Enrollment in and disenrollment from health maintenance organizations by Medicaid recipients.</p><p>volume: 6</p><p>year_period: 1985 Spring</p>]]></description></item><item><title>Managed Care and Dually Eligible Beneficiareis: Challenges in Coordination</title><pubDate>Mon, 04 Nov 2019 02:28:09 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191721</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191721</guid><description><![CDATA[<p>page_range: 63-82</p><p>primary_author: Walsh, Edith G.</p><p>title: Managed Care and Dually Eligible Beneficiareis: Challenges in Coordination</p><p>volume: 24</p><p>year_period: 2002 Fall</p>]]></description></item><item><title>Comorbidity-Based Payment Methodology for Medicaid Enrollees with HIV/AIDS</title><pubDate>Mon, 04 Nov 2019 02:28:09 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1214417</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1214417</guid><description><![CDATA[<p>page_range: Pg 53-68</p><p>primary_author: Fakhraei, S. Hamid</p><p>title: Comorbidity-Based Payment Methodology for Medicaid Enrollees with HIV/AIDS</p><p>volume: 23</p><p>year_period: 2001 Winter</p>]]></description></item><item><title>Historical Perspective on Adding Drugs to Medicare</title><pubDate>Mon, 04 Nov 2019 02:28:08 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1199301</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1199301</guid><description><![CDATA[<p>page_range: 25-34</p><p>primary_author: Santangelo, M.</p><p>title: Historical Perspective on Adding Drugs to Medicare</p><p>volume: 27</p><p>year_period: 2005 Winter</p>]]></description></item><item><title>Insurance Trends for the Medicare Population, 1991-1999</title><pubDate>Mon, 04 Nov 2019 02:28:08 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1214305</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1214305</guid><description><![CDATA[<p>page_range: 9-16</p><p>primary_author: Murray, Lauren A.</p><p>title: Insurance Trends for the Medicare Population, 1991-1999</p><p>volume: 23</p><p>year_period: 2002 Spring</p>]]></description></item><item><title>Payment Policy and Competition in the Medicare+Choice Program</title><pubDate>Mon, 04 Nov 2019 02:28:08 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191722</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191722</guid><description><![CDATA[<p>page_range: 83-94</p><p>primary_author: Pizer, Steven</p><p>title: Payment Policy and Competition in the Medicare+Choice Program</p><p>volume: 24</p><p>year_period: 2002 Fall</p>]]></description></item><item><title>Home Health, Facility, and Community Populations</title><pubDate>Mon, 04 Nov 2019 02:28:08 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1214440</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1214440</guid><description><![CDATA[<p>page_range: 211-214</p><p>primary_author: Murray, Lauren A.</p><p>title: Home Health, Facility, and Community Populations</p><p>volume: 20</p><p>year_period: 1999 Summer</p>]]></description></item><item><title>Beneficiary decisionmaking: The impact of labeling health plan choices.</title><pubDate>Mon, 04 Nov 2019 02:28:08 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191699</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191699</guid><description><![CDATA[<p>page_range: 63-75</p><p>primary_author: Fyock, Jack</p><p>title: Beneficiary decisionmaking: The impact of labeling health plan choices.</p><p>volume: 23</p><p>year_period: 2001 Fall</p>]]></description></item><item><title>Medicare Financial Status, Budget Impact, and Sustainability Which Concept is Which?</title><pubDate>Mon, 04 Nov 2019 02:28:08 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1204462</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1204462</guid><description><![CDATA[<p>page_range: 127-140</p><p>primary_author: Foster, R. S.</p><p>title: Medicare Financial Status, Budget Impact, and Sustainability Which Concept is Which?</p><p>volume: 27</p><p>year_period: 2005 Winter</p>]]></description></item><item><title>Ensuring Access tp Affodable Drug Coverage in Medicare fee-for-Service Medicare in a Competitive Mar</title><pubDate>Mon, 04 Nov 2019 02:28:08 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1204417</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1204417</guid><description><![CDATA[<p>page_range: 103-112</p><p>primary_author: Antos, J. R.</p><p>title: Ensuring Access tp Affodable Drug Coverage in Medicare fee-for-Service Medicare in a Competitive Mar</p><p>volume: 27</p><p>year_period: 2005 Winter</p>]]></description></item><item><title>Rural Hospital Wages and the Area Wage Index</title><pubDate>Mon, 04 Nov 2019 02:28:08 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191726</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191726</guid><description><![CDATA[<p>page_range: 155-176</p><p>primary_author: Dalton, Kathleen</p><p>title: Rural Hospital Wages and the Area Wage Index</p><p>volume: 24</p><p>year_period: 2002 Fall</p>]]></description></item><item><title>Continuous Case Management of a German StatutoryHealth Insurance</title><pubDate>Mon, 04 Nov 2019 02:28:08 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1198473</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1198473</guid><description><![CDATA[<p>page_range: 59-68</p><p>primary_author: Hecke, T. L.</p><p>title: Continuous Case Management of a German StatutoryHealth Insurance</p><p>volume: 27</p><p>year_period: 2005 Fall</p>]]></description></item><item><title>Disenrollment and Re-enrollment Patterns in a SCHIP</title><pubDate>Mon, 04 Nov 2019 02:28:08 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1214307</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1214307</guid><description><![CDATA[<p>page_range: 47-64</p><p>primary_author: Shenkman, Elizabeth</p><p>title: Disenrollment and Re-enrollment Patterns in a SCHIP</p><p>volume: 23</p><p>year_period: 2002 Spring</p>]]></description></item><item><title>Consumer Research on Messages to Prevent Medical Errors</title><pubDate>Mon, 04 Nov 2019 02:28:08 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1214421</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1214421</guid><description><![CDATA[<p>page_range: 199-201</p><p>primary_author: Rubenstein, Carol</p><p>title: Consumer Research on Messages to Prevent Medical Errors</p><p>volume: 22</p><p>year_period: 2001 Summer</p>]]></description></item><item><title>Osteoporosis and Hip Fractures in the Medicare Population, 1992-1996</title><pubDate>Mon, 04 Nov 2019 02:28:08 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1214442</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1214442</guid><description><![CDATA[<p>page_range: 123-128</p><p>primary_author: Davenport, Marsha G.</p><p>title: Osteoporosis and Hip Fractures in the Medicare Population, 1992-1996</p><p>volume: 21</p><p>year_period: 1999 Fall</p>]]></description></item><item><title>Information Needs and Preferences of the General Medicare Population</title><pubDate>Mon, 04 Nov 2019 02:28:08 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1214445</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1214445</guid><description><![CDATA[<p>page_range: 287-289</p><p>primary_author: Rubenstein, Carol</p><p>title: Information Needs and Preferences of the General Medicare Population</p><p>volume: 21</p><p>year_period: 1999 Winter</p>]]></description></item><item><title>Assessment of the National Medicare Education Program: Supply and Demand for Information</title><pubDate>Mon, 04 Nov 2019 02:28:08 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1214443</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1214443</guid><description><![CDATA[<p>page_range: 129-131</p><p>primary_author: Goldstein, Elizabeth</p><p>title: Assessment of the National Medicare Education Program: Supply and Demand for Information</p><p>volume: 21</p><p>year_period: 1999 Fall</p>]]></description></item><item><title>Changing Nature of Public and Private Health Insurance</title><pubDate>Mon, 04 Nov 2019 02:28:08 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1214304</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1214304</guid><description><![CDATA[<p>page_range: 1-8</p><p>primary_author: Goody, Brigid</p><p>title: Changing Nature of Public and Private Health Insurance</p><p>volume: 23</p><p>year_period: 2002 Spring</p>]]></description></item><item><title>Use of Conventional Antipsychotics and the Cost of Treating Schizophrenia</title><pubDate>Mon, 04 Nov 2019 02:28:08 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1214419</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1214419</guid><description><![CDATA[<p>page_range: Pg 83-100</p><p>primary_author: Lyu, Ramon R.</p><p>title: Use of Conventional Antipsychotics and the Cost of Treating Schizophrenia</p><p>volume: 23</p><p>year_period: 2001 Winter</p>]]></description></item><item><title>Financial Performance and Participation in Medicaid and Medi-Cal Managed Care</title><pubDate>Mon, 04 Nov 2019 02:28:08 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1214418</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1214418</guid><description><![CDATA[<p>page_range: Pg 69-82</p><p>primary_author: McCue, Michael J.</p><p>title: Financial Performance and Participation in Medicaid and Medi-Cal Managed Care</p><p>volume: 23</p><p>year_period: 2001 Winter</p>]]></description></item><item><title>A new approach to hospital cost functions and some issues in revenue regulation.</title><pubDate>Mon, 04 Nov 2019 02:28:07 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191836</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191836</guid><description><![CDATA[<p>abstract: An important aspect of hospital revenue regulation at the State level is the use of retroactive allowances for changes in the volume of service. Arguments favoring non-proportional allowances have been based on statistical studies of marginal cost, together with concerns about fairness toward non-profit enterprises or concerns about various inflationary biases in hospital management. This article attempts to review and clarify the regulatory issues and choices, with the aid of new econometric work that explicitly allows for the effects of transitory as well as expected demand changes on hospital expense. The present analysis is also novel in treating length of stay as an endogenous variable in cost functions. We analyzed cost variation for a panel of over 800 hospitals that reported monthly to Hospital Administrative Services between 1973 and 1978. The central results are that marginal cost of unexpected admissions is about half of average cost, while marginal cost of forecasted admissions is about equal to average cost. We obtained relatively low estimates of the cost of an "empty bed." The study tends to support proportional volume allowances in revenue regulation programs, with perhaps a residual role for selective case review.</p><p>authors: Pauly, Mark V</p><p>issue_mesh: Costs and Cost Analysis : Reimbursement Mechanisms : Comparative Study : Facility Regulation and Control/economics : Hospitalization/economics : Models, Theoretical : Regression Analysis : Support, U.S. Gov't, Non-P.H.S. : United States</p><p>issue_number: 3</p><p>ntis_number: PB83-175620</p><p>page_range: 105-114</p><p>primary_author: Friedman, Bernard</p><p>title: A new approach to hospital cost functions and some issues in revenue regulation.</p><p>volume: 4</p><p>year_period: 1983 Mar</p>]]></description></item><item><title>Strategies for Medicare Health Plans Serving Racial and Ethnic Minorities</title><pubDate>Mon, 04 Nov 2019 02:28:07 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1214320</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1214320</guid><description><![CDATA[<p>page_range: 131-147</p><p>primary_author: Langwell, Kathryn M.</p><p>title: Strategies for Medicare Health Plans Serving Racial and Ethnic Minorities</p><p>volume: 23</p><p>year_period: 2002 Summer</p>]]></description></item><item><title>Overview: 40th Anniversary of Medicare and Medicaid</title><pubDate>Mon, 04 Nov 2019 02:28:07 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1198592</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1198592</guid><description><![CDATA[<p>page_range: 5-10</p><p>primary_author: De Lew, N.</p><p>title: Overview: 40th Anniversary of Medicare and Medicaid</p><p>volume: 27</p><p>year_period: 2005 Winter</p>]]></description></item><item><title>Effect of Medicare Advantage Payments on Dually EligibleMedicare Beneficiaries</title><pubDate>Mon, 04 Nov 2019 02:28:07 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1196583</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1196583</guid><description><![CDATA[<p>page_range: 93-104</p><p>primary_author: Atherly, A.</p><p>title: Effect of Medicare Advantage Payments on Dually EligibleMedicare Beneficiaries</p><p>volume: 26</p><p>year_period: 2005 Spring</p>]]></description></item><item><title>Germany's Disease Management Program: Improving Outcomes in Congestive Heart Failure</title><pubDate>Mon, 04 Nov 2019 02:28:07 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1214267</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1214267</guid><description><![CDATA[<p>page_range: 79-88</p><p>primary_author: Kottmair, S.</p><p>title: Germany's Disease Management Program: Improving Outcomes in Congestive Heart Failure</p><p>volume: 27</p><p>year_period: 2005 Fall</p>]]></description></item><item><title>M+C Plan County Exit Decisions 1999-2001: Implications for Payment Policy</title><pubDate>Mon, 04 Nov 2019 02:28:07 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1196681</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1196681</guid><description><![CDATA[<p>page_range: 105-124</p><p>primary_author: Halpern, R.</p><p>title: M+C Plan County Exit Decisions 1999-2001: Implications for Payment Policy</p><p>volume: 26</p><p>year_period: 2005 Spring</p>]]></description></item><item><title>Mental-Behavioral Health Data: 2001 NHIS</title><pubDate>Mon, 04 Nov 2019 02:28:07 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1190358</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1190358</guid><description><![CDATA[<p>page_range: 137-141</p><p>primary_author: Lied, Terry</p><p>title: Mental-Behavioral Health Data: 2001 NHIS</p><p>volume: 26</p><p>year_period: 2004 Fall</p>]]></description></item><item><title>WHO's ICF and Functional Status Information in Health Records</title><pubDate>Mon, 04 Nov 2019 02:28:07 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191742</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191742</guid><description><![CDATA[<p>page_range: 77-88</p><p>primary_author: Ustun, Bedirhan</p><p>title: WHO's ICF and Functional Status Information in Health Records</p><p>volume: 24</p><p>year_period: 2003 Spring</p>]]></description></item><item><title>Access to Care Among Disabled Adults on Medicaid</title><pubDate>Mon, 04 Nov 2019 02:28:07 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1214322</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1214322</guid><description><![CDATA[<p>page_range: 159-173</p><p>primary_author: Long, Sharon K.</p><p>title: Access to Care Among Disabled Adults on Medicaid</p><p>volume: 23</p><p>year_period: 2002 Summer</p>]]></description></item><item><title>Home and Community - Based Services in Seven States</title><pubDate>Mon, 04 Nov 2019 02:28:07 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1214308</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1214308</guid><description><![CDATA[<p>page_range: 89-114</p><p>primary_author: Wiener, Joshua M.</p><p>title: Home and Community - Based Services in Seven States</p><p>volume: 23</p><p>year_period: 2002 Spring</p>]]></description></item><item><title>Nursing Home Work Environment Characteristics: Associated Outcomes in Psychosocial Care</title><pubDate>Mon, 04 Nov 2019 02:28:07 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1222290</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1222290</guid><description><![CDATA[<p>page_range: 19</p><p>primary_author: Bonifas, R. P.</p><p>title: Nursing Home Work Environment Characteristics: Associated Outcomes in Psychosocial Care</p><p>volume: 30</p><p>year_period: 2008 Winter</p>]]></description></item><item><title>Retiree Health Insurance: Recent Trends and Tomorrow's Prospects</title><pubDate>Mon, 04 Nov 2019 02:28:07 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1214306</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1214306</guid><description><![CDATA[<p>page_range: 17-34</p><p>primary_author: McCormack, Lauren A.</p><p>title: Retiree Health Insurance: Recent Trends and Tomorrow's Prospects</p><p>volume: 23</p><p>year_period: 2002 Spring</p>]]></description></item><item><title>Cost of Lifetime Immunosuppression Coverage for Kidney Transplant Recipients</title><pubDate>Mon, 04 Nov 2019 02:28:07 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1222307</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1222307</guid><description><![CDATA[<p>page_range: 95</p><p>primary_author: Page, T. F.</p><p>title: Cost of Lifetime Immunosuppression Coverage for Kidney Transplant Recipients</p><p>volume: 30</p><p>year_period: 2008 Winter</p>]]></description></item><item><title>Employment - Related Health Insurance: Federal Agencies' Roles in Meeting Data Needs</title><pubDate>Mon, 04 Nov 2019 02:28:07 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1214309</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1214309</guid><description><![CDATA[<p>page_range: 115-130</p><p>primary_author: Wiatrowski, William</p><p>title: Employment - Related Health Insurance: Federal Agencies' Roles in Meeting Data Needs</p><p>volume: 23</p><p>year_period: 2002 Spring</p>]]></description></item><item><title>Reducing Bias in Cancer Research: Application of Propensity Score Matching</title><pubDate>Mon, 04 Nov 2019 02:28:07 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1216290</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1216290</guid><description><![CDATA[<p>page_range: 69</p><p>primary_author: Reeve, B. B.</p><p>title: Reducing Bias in Cancer Research: Application of Propensity Score Matching</p><p>volume: 29</p><p>year_period: 2008 Summer</p>]]></description></item><item><title>Including Disenrollees I CAHPS Managed Care Healt Plan Assessment Reporting</title><pubDate>Mon, 04 Nov 2019 02:28:07 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191762</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191762</guid><description><![CDATA[<p>page_range: 67-78</p><p>primary_author: Bender, Randall</p><p>title: Including Disenrollees I CAHPS Managed Care Healt Plan Assessment Reporting</p><p>volume: 25</p><p>year_period: 2003 Fall</p>]]></description></item><item><title>Differences among black, Hispanic, and white people in knowledge about long-term care services.</title><pubDate>Mon, 04 Nov 2019 02:28:07 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191857</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191857</guid><description><![CDATA[<p>abstract: This article provides data obtained through telephone interviews with 1,608 white, black, Mexican American, or Puerto Rican respondents. The study was designed to measure differences among ethnic groups in knowledge and attitudes toward long-term care services and the extent to which knowledge and attitudes affect service use. Across all groups, there is less knowledge about long-term, community-based care than institutional services. The extent of knowledge about services is limited among all groups, but especially among Puerto Ricans. There are marked differences among groups in attitudes toward services. Minority groups are far more likely to perceive care of the elderly as a family responsibility and to stress the importance of ethnic factors in service delivery. Despite differences among groups, knowledge and attitudes are less directly related to use of services than is activity limitation. This may be because only a very small proportion of the respondents had any experience with service use.</p><p>authors: Holmes, Monica; Teresi, Jeanne</p><p>issue_mesh: Attitude to Health : Analysis of Variance : Blacks/psychology : Comparative Study : Consumer Participation : Hispanic Americans/psychology : Human : Long-Term Care/psychology : Support, U.S. Gov't, P.H.S. : United States : Whites/psychology</p><p>issue_number: 2</p><p>ntis_number: PB84-185321</p><p>page_range: 51-67</p><p>primary_author: Holmes, Douglas</p><p>title: Differences among black, Hispanic, and white people in knowledge about long-term care services.</p><p>volume: 5</p><p>year_period: 1983 Winter</p>]]></description></item><item><title>Care for the chronically ill: nursing home incentive payment experience.</title><pubDate>Mon, 04 Nov 2019 02:28:07 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191856</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191856</guid><description><![CDATA[<p>abstract: Nursing home reimbursement systems which do not adjust payment levels to patient care needs lead to access problems for heavy-care patients. Unnecessarily long and costly hospital stays may result. A patient-based nursing home incentive reimbursement system has been designed and is being evaluated in a controlled field experiment in 36 California skilled nursing facilities. Incentives are paid for admitting heavy-care patients, meeting outcome goals on some patients, and discharging and maintaining some patients in the community. This article describes a nursing home reimbursement system which is intended to simultaneously mitigate problems of restricted access, inefficient use of beds, and nonoptimal care. It also discusses the approach to evaluating this broad social intervention by application of a controlled experimental design.</p><p>authors: Scanlon, William J; Skinner, Douglas E; Wan, Thomas T</p><p>issue_mesh: Costs and Cost Analysis : Diagnosis-Related Groups : Reimbursement Mechanisms : Reimbursement, Incentive : California : Chronic Disease : Human : Medicaid : Nursing Homes/economics : Pilot Projects : Task Performance and Analysis</p><p>issue_number: 2</p><p>ntis_number: PB84-185321</p><p>page_range: 41-49</p><p>primary_author: Weissert, William G</p><p>title: Care for the chronically ill: nursing home incentive payment experience.</p><p>volume: 5</p><p>year_period: 1983 Winter</p>]]></description></item><item><title>Prescription Drug Coverage Among Medicare Beneficiaries</title><pubDate>Mon, 04 Nov 2019 02:28:06 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1206468</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1206468</guid><description><![CDATA[<p>page_range: 119-126</p><p>primary_author: Regan, J. F.</p><p>title: Prescription Drug Coverage Among Medicare Beneficiaries</p><p>volume: 29</p><p>year_period: 2007 Fall</p>]]></description></item><item><title>Prevalence of Select Psychiatric Diagnoses in Long-Term Care: 1997-2007</title><pubDate>Mon, 04 Nov 2019 02:28:06 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1222308</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1222308</guid><description><![CDATA[<p>page_range: 105</p><p>primary_author: Regan, J. F.</p><p>title: Prevalence of Select Psychiatric Diagnoses in Long-Term Care: 1997-2007</p><p>volume: 30</p><p>year_period: 2008 Winter</p>]]></description></item><item><title>Health Care Quality Reporting: Changes and Challenges</title><pubDate>Mon, 04 Nov 2019 02:28:06 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1206493</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1206493</guid><description><![CDATA[<p>page_range: 1-4</p><p>primary_author: Miranda, D. J.</p><p>title: Health Care Quality Reporting: Changes and Challenges</p><p>volume: 28</p><p>year_period: 2007 Spring</p>]]></description></item><item><title>Risk Adjustment and Public Reporting on Home Health Care</title><pubDate>Mon, 04 Nov 2019 02:28:06 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1206499</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1206499</guid><description><![CDATA[<p>page_range: 77-94</p><p>primary_author: Murtaugh, C. M.</p><p>title: Risk Adjustment and Public Reporting on Home Health Care</p><p>volume: 28</p><p>year_period: 2007 Spring</p>]]></description></item><item><title>Evolution of State Outreach Efforts Under SCHIP</title><pubDate>Mon, 04 Nov 2019 02:28:06 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1206490</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1206490</guid><description><![CDATA[<p>page_range: 95-107</p><p>primary_author: Williams, S. R.</p><p>title: Evolution of State Outreach Efforts Under SCHIP</p><p>volume: 28</p><p>year_period: 2007 Summer</p>]]></description></item><item><title>Functional Impairment Levels in PACE Enrollees</title><pubDate>Mon, 04 Nov 2019 02:28:06 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1216291</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1216291</guid><description><![CDATA[<p>page_range: 81</p><p>primary_author: Walsh, E. G.</p><p>title: Functional Impairment Levels in PACE Enrollees</p><p>volume: 29</p><p>year_period: 2008 Summer</p>]]></description></item><item><title>Alternative Comorbidity Adjustors for the Medicare Inpatient Psychiatric Facility PPS [</title><pubDate>Mon, 04 Nov 2019 02:28:06 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1222305</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1222305</guid><description><![CDATA[<p>page_range: 67</p><p>primary_author: Drozd, E. M.</p><p>title: Alternative Comorbidity Adjustors for the Medicare Inpatient Psychiatric Facility PPS [</p><p>volume: 30</p><p>year_period: 2008 Winter</p>]]></description></item><item><title>Emerging Issues of Pay-for-Performance in Health Care</title><pubDate>Mon, 04 Nov 2019 02:28:06 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1206458</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1206458</guid><description><![CDATA[<p>page_range: 1-4</p><p>primary_author: Thomas, F. G.</p><p>title: Emerging Issues of Pay-for-Performance in Health Care</p><p>volume: 29</p><p>year_period: 2007 Fall</p>]]></description></item><item><title>Cancer, Comorbidities, and HealthRelated Older Adults</title><pubDate>Mon, 04 Nov 2019 02:28:06 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1216288</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1216288</guid><description><![CDATA[<p>page_range: 41</p><p>primary_author: Smith A. W.</p><p>title: Cancer, Comorbidities, and HealthRelated Older Adults</p><p>volume: 29</p><p>year_period: 2008 Summer</p>]]></description></item><item><title>Reconciling Medical expenditure Estimates from the MEPS and NHEA, 2002</title><pubDate>Mon, 04 Nov 2019 02:28:06 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1205330</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1205330</guid><description><![CDATA[<p>page_range: 25-40</p><p>primary_author: Sing, M.</p><p>title: Reconciling Medical expenditure Estimates from the MEPS and NHEA, 2002</p><p>volume: 28</p><p>year_period: 2006 Fall</p>]]></description></item><item><title>2003 Medicaid Versus Commercial Beneficiary Experience with Care</title><pubDate>Mon, 04 Nov 2019 02:28:06 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1197025</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1197025</guid><description><![CDATA[<p>page_range: 109-116</p><p>primary_author: Lied, T. R.</p><p>title: 2003 Medicaid Versus Commercial Beneficiary Experience with Care</p><p>volume: 26</p><p>year_period: 2005 Summer</p>]]></description></item><item><title>Composite Health Plan Quality Scales</title><pubDate>Mon, 04 Nov 2019 02:28:06 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1206500</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1206500</guid><description><![CDATA[<p>page_range: 95-108</p><p>primary_author: Caldis, T.</p><p>title: Composite Health Plan Quality Scales</p><p>volume: 28</p><p>year_period: 2007 Spring</p>]]></description></item><item><title>Medicaid's Expenditures for Newer Pharmacotherapies for Adults with Disabilities</title><pubDate>Mon, 04 Nov 2019 02:28:06 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1206484</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1206484</guid><description><![CDATA[<p>page_range: 31-42</p><p>primary_author: Shireman, T. I.</p><p>title: Medicaid's Expenditures for Newer Pharmacotherapies for Adults with Disabilities</p><p>volume: 28</p><p>year_period: 2007 Summer</p>]]></description></item><item><title>Effect of Medicaid Payment on Rehabilitation Care for Nursing Home Residents</title><pubDate>Mon, 04 Nov 2019 02:28:06 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1206504</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1206504</guid><description><![CDATA[<p>page_range: 117-130</p><p>primary_author: Wodchis, W. P.</p><p>title: Effect of Medicaid Payment on Rehabilitation Care for Nursing Home Residents</p><p>volume: 28</p><p>year_period: 2007 Spring</p>]]></description></item><item><title>Hospital Response to Public Reporting of Quality Indicators</title><pubDate>Mon, 04 Nov 2019 02:28:06 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1206498</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1206498</guid><description><![CDATA[<p>page_range: 61-76</p><p>primary_author: Laschober, M.</p><p>title: Hospital Response to Public Reporting of Quality Indicators</p><p>volume: 28</p><p>year_period: 2007 Spring</p>]]></description></item><item><title>Impact of Drug Coverage on Medical Expenditures Among the Elderly</title><pubDate>Mon, 04 Nov 2019 02:28:06 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1206467</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1206467</guid><description><![CDATA[<p>page_range: 103-118</p><p>primary_author: Gilman, B. H.</p><p>title: Impact of Drug Coverage on Medical Expenditures Among the Elderly</p><p>volume: 29</p><p>year_period: 2007 Fall</p>]]></description></item><item><title>Understanding and Improving Psychosocial Services in Long-Term Care</title><pubDate>Mon, 04 Nov 2019 02:28:06 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1222287</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1222287</guid><description><![CDATA[<p>page_range: 1</p><p>primary_author: Bowen, S. E..</p><p>title: Understanding and Improving Psychosocial Services in Long-Term Care</p><p>volume: 30</p><p>year_period: 2008 Winter</p>]]></description></item><item><title>Medicare's Quality Improvement Organization Program Value in Nursing Homes</title><pubDate>Mon, 04 Nov 2019 02:28:06 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1206503</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1206503</guid><description><![CDATA[<p>page_range: 109-116</p><p>primary_author: Shih, A.</p><p>title: Medicare's Quality Improvement Organization Program Value in Nursing Homes</p><p>volume: 28</p><p>year_period: 2007 Spring</p>]]></description></item><item><title>Medicaid Waiver Personal Care Services: Results of a Statewide Survey</title><pubDate>Mon, 04 Nov 2019 02:28:06 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1222292</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1222292</guid><description><![CDATA[<p>page_range: 53</p><p>primary_author: Glass, A. P.</p><p>title: Medicaid Waiver Personal Care Services: Results of a Statewide Survey</p><p>volume: 30</p><p>year_period: 2008 Winter</p>]]></description></item><item><title>Effects of Green House Nursing Homes on Residents' Families</title><pubDate>Mon, 04 Nov 2019 02:28:06 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1222291</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1222291</guid><description><![CDATA[<p>page_range: 35</p><p>primary_author: Lum, T. Y.</p><p>title: Effects of Green House Nursing Homes on Residents' Families</p><p>volume: 30</p><p>year_period: 2008 Winter</p>]]></description></item><item><title>Facility Service Environments, Staffing, and Psychosocial Care in Nursing Homes</title><pubDate>Mon, 04 Nov 2019 02:28:04 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1222288</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1222288</guid><description><![CDATA[<p>page_range: 5</p><p>primary_author: Zhang, N. J.</p><p>title: Facility Service Environments, Staffing, and Psychosocial Care in Nursing Homes</p><p>volume: 30</p><p>year_period: 2008 Winter</p>]]></description></item><item><title>Medicare Risk Adjustment for the Frail Elderly</title><pubDate>Mon, 04 Nov 2019 02:28:04 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1222306</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1222306</guid><description><![CDATA[<p>page_range: 83</p><p>primary_author: Kautter, J.</p><p>title: Medicare Risk Adjustment for the Frail Elderly</p><p>volume: 30</p><p>year_period: 2008 Winter</p>]]></description></item><item><title>Testing Consumers' Comprehension of Quality Measures Using Alternative Reporting Formats</title><pubDate>Mon, 04 Nov 2019 02:28:04 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1206496</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1206496</guid><description><![CDATA[<p>page_range: 31-46</p><p>primary_author: Gerteis, M.</p><p>title: Testing Consumers' Comprehension of Quality Measures Using Alternative Reporting Formats</p><p>volume: 28</p><p>year_period: 2007 Spring</p>]]></description></item><item><title>Physician Code Creep: Evidence in Medicaid and State Employee Health Insurance Billing</title><pubDate>Mon, 04 Nov 2019 02:28:04 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1206489</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1206489</guid><description><![CDATA[<p>page_range: 83-94</p><p>primary_author: Seiber, E. E.</p><p>title: Physician Code Creep: Evidence in Medicaid and State Employee Health Insurance Billing</p><p>volume: 28</p><p>year_period: 2007 Summer</p>]]></description></item><item><title>Resource Utilization and Costs of Age-Related Macular Degeneration</title><pubDate>Mon, 04 Nov 2019 02:28:04 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1205864</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1205864</guid><description><![CDATA[<p>page_range: 37-47</p><p>primary_author: Halpern, M.T.</p><p>title: Resource Utilization and Costs of Age-Related Macular Degeneration</p><p>volume: 27</p><p>year_period: 2006 Spring</p>]]></description></item><item><title>HMO Penetration, Hospital Competition, and Growth of Ambulatory Surgery Centers</title><pubDate>Mon, 04 Nov 2019 02:28:04 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1205556</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1205556</guid><description><![CDATA[<p>page_range: 111-122</p><p>primary_author: Bian, J.</p><p>title: HMO Penetration, Hospital Competition, and Growth of Ambulatory Surgery Centers</p><p>volume: 27</p><p>year_period: 2006 Summer</p>]]></description></item><item><title>Pioneering Pay-for-Quality: Lessons from the Rewarding Results Demonstrations</title><pubDate>Mon, 04 Nov 2019 02:28:04 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1206463</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1206463</guid><description><![CDATA[<p>page_range: 59-70</p><p>primary_author: Young, G. J.</p><p>title: Pioneering Pay-for-Quality: Lessons from the Rewarding Results Demonstrations</p><p>volume: 29</p><p>year_period: 2007 Fall</p>]]></description></item><item><title>Financial Gains and Risks in Pay-for-Performance Bonus Algorithms</title><pubDate>Mon, 04 Nov 2019 02:28:04 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1206459</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1206459</guid><description><![CDATA[<p>page_range: 5-14</p><p>primary_author: Cromwell, J.</p><p>title: Financial Gains and Risks in Pay-for-Performance Bonus Algorithms</p><p>volume: 29</p><p>year_period: 2007 Fall</p>]]></description></item><item><title>End of Life Medicare and Medicaid Expenditures for Dually Eligible Beneficiaries</title><pubDate>Mon, 04 Nov 2019 02:28:04 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1205555</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1205555</guid><description><![CDATA[<p>page_range: 95-110</p><p>primary_author: Liu, K.</p><p>title: End of Life Medicare and Medicaid Expenditures for Dually Eligible Beneficiaries</p><p>volume: 27</p><p>year_period: 2006 Summer</p>]]></description></item><item><title>Partially Capitated Managed Care Versus FFS for Special Needs Children</title><pubDate>Mon, 04 Nov 2019 02:28:04 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1206491</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1206491</guid><description><![CDATA[<p>page_range: 109-124</p><p>primary_author: Schuster, C. R.</p><p>title: Partially Capitated Managed Care Versus FFS for Special Needs Children</p><p>volume: 28</p><p>year_period: 2007 Summer</p>]]></description></item><item><title>Medicare Physician Group Practice Demonstration Design:Quality and Efficiency Pay-for-Performance</title><pubDate>Mon, 04 Nov 2019 02:28:04 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1206461</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1206461</guid><description><![CDATA[<p>page_range: 15-30</p><p>primary_author: Kautter, J.</p><p>title: Medicare Physician Group Practice Demonstration Design:Quality and Efficiency Pay-for-Performance</p><p>volume: 29</p><p>year_period: 2007 Fall</p>]]></description></item><item><title>Depressed Mood and Mental Health Among Elderly Medicare Managed Care Enrollees</title><pubDate>Mon, 04 Nov 2019 02:28:04 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1205557</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1205557</guid><description><![CDATA[<p>page_range: 123-136</p><p>primary_author: Bierman, A. S.</p><p>title: Depressed Mood and Mental Health Among Elderly Medicare Managed Care Enrollees</p><p>volume: 27</p><p>year_period: 2006 Summer</p>]]></description></item><item><title>Public Reporting of Quality Information on Medicaid Health Plans</title><pubDate>Mon, 04 Nov 2019 02:28:04 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1206494</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1206494</guid><description><![CDATA[<p>page_range: 5-16</p><p>primary_author: Felt-Lisk, S.</p><p>title: Public Reporting of Quality Information on Medicaid Health Plans</p><p>volume: 28</p><p>year_period: 2007 Spring</p>]]></description></item><item><title>Measures and Predictors of Medicare Knowledge: A Review of the Literature</title><pubDate>Mon, 04 Nov 2019 02:28:04 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1205487</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1205487</guid><description><![CDATA[<p>page_range: 1-12</p><p>primary_author: Greenwald, L. M.</p><p>title: Measures and Predictors of Medicare Knowledge: A Review of the Literature</p><p>volume: 27</p><p>year_period: 2006 Summer</p>]]></description></item><item><title>Diagnosis-Based Risk Adjustment for Medicare Prescription Drug Plan Payments</title><pubDate>Mon, 04 Nov 2019 02:28:04 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1206483</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1206483</guid><description><![CDATA[<p>page_range: 15-30</p><p>primary_author: Robst, J.</p><p>title: Diagnosis-Based Risk Adjustment for Medicare Prescription Drug Plan Payments</p><p>volume: 28</p><p>year_period: 2007 Summer</p>]]></description></item><item><title>Understanding the Reporting Practices of CAHPS Sponsors</title><pubDate>Mon, 04 Nov 2019 02:28:04 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1206495</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1206495</guid><description><![CDATA[<p>page_range: 17-30</p><p>primary_author: Teleki, S. S.</p><p>title: Understanding the Reporting Practices of CAHPS Sponsors</p><p>volume: 28</p><p>year_period: 2007 Spring</p>]]></description></item><item><title>Medicare Beneficiary Knowledge of and Experience with Prescription Drug Cards</title><pubDate>Mon, 04 Nov 2019 02:28:04 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1206466</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1206466</guid><description><![CDATA[<p>page_range: 87-102</p><p>primary_author: Rudolph, N. V.</p><p>title: Medicare Beneficiary Knowledge of and Experience with Prescription Drug Cards</p><p>volume: 29</p><p>year_period: 2007 Fall</p>]]></description></item><item><title>Hospital Size, Uncertainty, and Pay-for-Performance</title><pubDate>Mon, 04 Nov 2019 02:28:04 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1206462</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1206462</guid><description><![CDATA[<p>page_range: 45-58</p><p>primary_author: Davidson, G.</p><p>title: Hospital Size, Uncertainty, and Pay-for-Performance</p><p>volume: 29</p><p>year_period: 2007 Fall</p>]]></description></item><item><title>Disenrollment Information and Medicare Plan Choice: Is More Information Better?</title><pubDate>Mon, 04 Nov 2019 02:28:04 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1206497</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1206497</guid><description><![CDATA[<p>page_range: 47-60</p><p>primary_author: Spranca, M. D.</p><p>title: Disenrollment Information and Medicare Plan Choice: Is More Information Better?</p><p>volume: 28</p><p>year_period: 2007 Spring</p>]]></description></item><item><title>Legislating Medicaid: Considering Medicaid and Its Origin</title><pubDate>Mon, 04 Nov 2019 02:28:03 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1200239</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1200239</guid><description><![CDATA[<p>page_range: 45-52</p><p>primary_author: Moore, J. D.</p><p>title: Legislating Medicaid: Considering Medicaid and Its Origin</p><p>volume: 27</p><p>year_period: 2005 Winter</p>]]></description></item><item><title>Prescription Drug Use and Expenditures Among Dually Eligible Beneficiaries</title><pubDate>Mon, 04 Nov 2019 02:28:03 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1206485</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1206485</guid><description><![CDATA[<p>page_range: 43-56</p><p>primary_author: Bagchi, A. D.</p><p>title: Prescription Drug Use and Expenditures Among Dually Eligible Beneficiaries</p><p>volume: 28</p><p>year_period: 2007 Summer</p>]]></description></item><item><title>Using diagnoses to describe populations and predict costs</title><pubDate>Mon, 04 Nov 2019 02:28:03 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191626</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191626</guid><description><![CDATA[<p>page_range: 7-28</p><p>primary_author: Ash, Arlene S</p><p>title: Using diagnoses to describe populations and predict costs</p><p>volume: 21</p><p>year_period: 2000 Spring</p>]]></description></item><item><title>Disabled Medicare Beneficiaries by Dual Eligible Status: California, 1996-2001</title><pubDate>Mon, 04 Nov 2019 02:28:03 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1206487</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1206487</guid><description><![CDATA[<p>page_range: 57-68</p><p>primary_author: O'Leary,J. F.</p><p>title: Disabled Medicare Beneficiaries by Dual Eligible Status: California, 1996-2001</p><p>volume: 28</p><p>year_period: 2007 Summer</p>]]></description></item><item><title>Nursing home pre- admission screening: a review of state programs.</title><pubDate>Mon, 04 Nov 2019 02:28:03 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191813</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191813</guid><description><![CDATA[<p>abstract: From January through March of 1981, the Health Care Financing Administration (HCFA) surveyed the agencies of 49 States and the District of Columbia responsible for the administration of the Medicaid program. The purpose of the survey was to determine if the agencies had a nursing home pre-admission screening program for Medicaid patients. Twenty-eight States and the District of Columbia responded that there was a state-wide, pre-admission screening program for Medicaid patients prior to their entry into a nursing home, or that there was a program operating in a portion of the State. HCFA collected information on the scope of the programs, the agencies responsible for conducting pre-admission screening, the composition of the screening teams, and the characteristics of the client assessment instruments. Two States, Virginia and Massachusetts, provided information on program impact. This article presents the findings of the survey and explores several aspects of the Medicaid program influencing the effectiveness of pre-admission screening. It begins with an overview of the policy issues which have influenced the development of pre-admission screening and defines the core components of these programs.</p><p>authors: Clauser, Steven B; Fatula, James</p><p>issue_mesh: Utilization Review : Aged : Eligibility Determination : Human : Massachusetts : Medicaid/utilization : Nursing Homes/utilization : Patient Care Planning/organization &#x26; administration : United States : Virginia</p><p>issue_number: 3</p><p>ntis_number: PB82-203878</p><p>page_range: 75-87</p><p>primary_author: Knowlton, Jackson</p><p>title: Nursing home pre- admission screening: a review of state programs.</p><p>volume: 3</p><p>year_period: 1982 Mar</p>]]></description></item><item><title>Medicaid's Role in the Many Markets for Health Care</title><pubDate>Mon, 04 Nov 2019 02:28:03 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1206488</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1206488</guid><description><![CDATA[<p>page_range: 69-82</p><p>primary_author: Quinn, K.</p><p>title: Medicaid's Role in the Many Markets for Health Care</p><p>volume: 28</p><p>year_period: 2007 Summer</p>]]></description></item><item><title>Trends and regional variations in hospital use under Medicare.</title><pubDate>Mon, 04 Nov 2019 02:28:03 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191812</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191812</guid><description><![CDATA[<p>abstract: Large regional differences have long been noted in hospital admission rates, in average length of stay, and in the days of care rate for Medicare beneficiaries. This paper provides an overview of national trends in the use of inpatient hospital services by Medicare beneficiaries and reviews past work on geographic differences in hospital use. It reassesses Medicare program experience and provides some new views on the subject. Perhaps the most surprising finding from this re-examination of regional differences in hospital use is that the number of days of care per capita in one area can differ substantially from that of another area while the per capita costs of care can be nearly equal. The major conclusion from this study is that no one utilization statistic is adequate for supplying information for the many current policy issues. Rather, there is a continuing need to understand national trends and regional differences in hospital utilization and to study the disparities by area in Medicare per capita spending for program benefits.</p><p>authors: N/A</p><p>issue_mesh: Age Factors : Aged : Comparative Study : Diagnosis-Related Groups : Hospitalization/trends : Human : Length of Stay/trends : Male : Medicare/utilization : Patient Discharge/trends : Time Factors : United States</p><p>issue_number: 3</p><p>ntis_number: PB82-203878</p><p>page_range: 41-73</p><p>primary_author: Gornick, Marian</p><p>title: Trends and regional variations in hospital use under Medicare.</p><p>volume: 3</p><p>year_period: 1982 Mar</p>]]></description></item><item><title>Medicare Disease Management in Policy Context</title><pubDate>Mon, 04 Nov 2019 02:28:03 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1216246</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1216246</guid><description><![CDATA[<p>page_range: 1</p><p>primary_author: Linden, A.</p><p>title: Medicare Disease Management in Policy Context</p><p>volume: 29</p><p>year_period: 2008 Spring</p>]]></description></item><item><title>Significance of Medicare and Medicaid Programs for the Practice of Medicine</title><pubDate>Mon, 04 Nov 2019 02:28:03 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1200580</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1200580</guid><description><![CDATA[<p>page_range: 79-90</p><p>primary_author: DeWalt, D. A.</p><p>title: Significance of Medicare and Medicaid Programs for the Practice of Medicine</p><p>volume: 27</p><p>year_period: 2005 Winter</p>]]></description></item><item><title>Site Randomized Trial of Coordinated Care in Medicare FFS</title><pubDate>Mon, 04 Nov 2019 02:28:03 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1220335</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1220335</guid><description><![CDATA[<p>page_range: 5</p><p>primary_author: Brown, R.</p><p>title: Site Randomized Trial of Coordinated Care in Medicare FFS</p><p>volume: 30</p><p>year_period: 2008 Fall</p>]]></description></item><item><title>Increasing Colorectal Cancer Testing: Translating Physician Interventions Into Population-Based</title><pubDate>Mon, 04 Nov 2019 02:28:03 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1205854</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1205854</guid><description><![CDATA[<p>page_range: 25-35</p><p>primary_author: Schenck, P. A.</p><p>title: Increasing Colorectal Cancer Testing: Translating Physician Interventions Into Population-Based</p><p>volume: 27</p><p>year_period: 2006 Spring</p>]]></description></item><item><title>Overview: Medicare and Prevention</title><pubDate>Mon, 04 Nov 2019 02:28:03 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1205851</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1205851</guid><description><![CDATA[<p>page_range: 1-4</p><p>primary_author: Lapin, P.</p><p>title: Overview: Medicare and Prevention</p><p>volume: 27</p><p>year_period: 2006 Spring</p>]]></description></item><item><title>SCHIP Structure and Children's Use of Care</title><pubDate>Mon, 04 Nov 2019 02:28:03 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1205549</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1205549</guid><description><![CDATA[<p>page_range: 41-51</p><p>primary_author: Bronstein, J. M.</p><p>title: SCHIP Structure and Children's Use of Care</p><p>volume: 27</p><p>year_period: 2006 Summer</p>]]></description></item><item><title>Case Selection for a Medicaid Chronic Care Management</title><pubDate>Mon, 04 Nov 2019 02:28:03 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1220339</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1220339</guid><description><![CDATA[<p>page_range: 61</p><p>primary_author: Weir, S.</p><p>title: Case Selection for a Medicaid Chronic Care Management</p><p>volume: 30</p><p>year_period: 2008 Fall</p>]]></description></item><item><title>Dually Eligible Enrollees: 2002</title><pubDate>Mon, 04 Nov 2019 02:28:03 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1205558</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1205558</guid><description><![CDATA[<p>page_range: 137-144</p><p>primary_author: Lied, T. R.</p><p>title: Dually Eligible Enrollees: 2002</p><p>volume: 27</p><p>year_period: 2006 Summer</p>]]></description></item><item><title>Overview: Disease Management</title><pubDate>Mon, 04 Nov 2019 02:28:03 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1220334</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1220334</guid><description><![CDATA[<p>page_range: 1</p><p>primary_author: Kapp, M. C.</p><p>title: Overview: Disease Management</p><p>volume: 30</p><p>year_period: 2008 Fall</p>]]></description></item><item><title>Profiling Efficiency and Quality of Physician Organizations in Medicare</title><pubDate>Mon, 04 Nov 2019 02:28:03 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1206460</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1206460</guid><description><![CDATA[<p>page_range: 31-44</p><p>primary_author: Pope, G. C.</p><p>title: Profiling Efficiency and Quality of Physician Organizations in Medicare</p><p>volume: 29</p><p>year_period: 2007 Fall</p>]]></description></item><item><title>Predictors of Preventive Service Use Among Medicare Beneficiaries</title><pubDate>Mon, 04 Nov 2019 02:28:03 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1205852</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1205852</guid><description><![CDATA[<p>page_range: 5-23</p><p>primary_author: Ozminkowski, R. J.</p><p>title: Predictors of Preventive Service Use Among Medicare Beneficiaries</p><p>volume: 27</p><p>year_period: 2006 Spring</p>]]></description></item><item><title>Identifying Potentially Preventable Readmissions</title><pubDate>Mon, 04 Nov 2019 02:28:03 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1220340</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1220340</guid><description><![CDATA[<p>page_range: 75</p><p>primary_author: Goldfield, N. I.</p><p>title: Identifying Potentially Preventable Readmissions</p><p>volume: 30</p><p>year_period: 2008 Fall</p>]]></description></item><item><title>Workforce Issues and Consumer Satisfaction in Medicaid Personal Assistance Services</title><pubDate>Mon, 04 Nov 2019 02:28:02 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1205379</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1205379</guid><description><![CDATA[<p>page_range: 87-101</p><p>primary_author: Anderson, W. L.</p><p>title: Workforce Issues and Consumer Satisfaction in Medicaid Personal Assistance Services</p><p>volume: 28</p><p>year_period: 2006 Fall</p>]]></description></item><item><title>Medicare Preferred Provider Organization Demonstration: Plan Offerings and Beneficiary Enrollment</title><pubDate>Mon, 04 Nov 2019 02:28:02 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1205877</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1205877</guid><description><![CDATA[<p>page_range: 95-109</p><p>primary_author: Pope, G. C.</p><p>title: Medicare Preferred Provider Organization Demonstration: Plan Offerings and Beneficiary Enrollment</p><p>volume: 27</p><p>year_period: 2006 Spring</p>]]></description></item><item><title>Alcohol Consumption in Older Adults and Medicare Costs</title><pubDate>Mon, 04 Nov 2019 02:28:02 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1205869</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1205869</guid><description><![CDATA[<p>page_range: 49-61</p><p>primary_author: Mukamal, K. J.</p><p>title: Alcohol Consumption in Older Adults and Medicare Costs</p><p>volume: 27</p><p>year_period: 2006 Spring</p>]]></description></item><item><title>Valuing Hospital Investment in Information Technology: Does Governance Make a Difference?</title><pubDate>Mon, 04 Nov 2019 02:28:02 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1205266</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1205266</guid><description><![CDATA[<p>page_range: 31-44</p><p>primary_author: Parente, S. T.</p><p>title: Valuing Hospital Investment in Information Technology: Does Governance Make a Difference?</p><p>volume: 28</p><p>year_period: 2006 Winter</p>]]></description></item><item><title>Cost Weight Compression: Impact of Cost Data Precision and Completeness</title><pubDate>Mon, 04 Nov 2019 02:28:02 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1205878</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1205878</guid><description><![CDATA[<p>page_range: 111-122</p><p>primary_author: Botz, C. K.</p><p>title: Cost Weight Compression: Impact of Cost Data Precision and Completeness</p><p>volume: 27</p><p>year_period: 2006 Spring</p>]]></description></item><item><title>Risk-Adjustment System for the Medicare Capitated ESRD Program</title><pubDate>Mon, 04 Nov 2019 02:28:02 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1205550</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1205550</guid><description><![CDATA[<p>page_range: 53-69</p><p>primary_author: Levy, J. M.</p><p>title: Risk-Adjustment System for the Medicare Capitated ESRD Program</p><p>volume: 27</p><p>year_period: 2006 Summer</p>]]></description></item><item><title>Identifying Potentially Preventable Complications Using a Present on Admission Indicator</title><pubDate>Mon, 04 Nov 2019 02:28:02 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1205875</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1205875</guid><description><![CDATA[<p>page_range: 63-82</p><p>primary_author: Hughes, J. S.</p><p>title: Identifying Potentially Preventable Complications Using a Present on Admission Indicator</p><p>volume: 27</p><p>year_period: 2006 Spring</p>]]></description></item><item><title>SEER-MHOS: A New Federal Collaboration on Cancer Outcomes Research</title><pubDate>Mon, 04 Nov 2019 02:28:02 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1216285</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1216285</guid><description><![CDATA[<p>page_range: 1</p><p>primary_author: Clauser, S. B.</p><p>title: SEER-MHOS: A New Federal Collaboration on Cancer Outcomes Research</p><p>volume: 29</p><p>year_period: 2008 Summer</p>]]></description></item><item><title>Characteristics and Perceptions of the Medicare Population: 2001-2005</title><pubDate>Mon, 04 Nov 2019 02:28:02 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1216279</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1216279</guid><description><![CDATA[<p>page_range: 59</p><p>primary_author: Murgolo, M.</p><p>title: Characteristics and Perceptions of the Medicare Population: 2001-2005</p><p>volume: 29</p><p>year_period: 2008 Spring</p>]]></description></item><item><title>Access and Satisfaction Among Children in Georgia s Medicaid Program and SCHIP: 2000 to 2003</title><pubDate>Mon, 04 Nov 2019 02:28:02 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1216282</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1216282</guid><description><![CDATA[<p>page_range: 43</p><p>primary_author: Adams, E. K.</p><p>title: Access and Satisfaction Among Children in Georgia s Medicaid Program and SCHIP: 2000 to 2003</p><p>volume: Volume 29</p><p>year_period: 2008 Spring</p>]]></description></item><item><title>State Medicaid programs offering personal care services.</title><pubDate>Mon, 04 Nov 2019 02:28:02 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191691</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191691</guid><description><![CDATA[<p>page_range: 155-173</p><p>primary_author: LeBlanc, Allen J</p><p>title: State Medicaid programs offering personal care services.</p><p>volume: 22</p><p>year_period: 2001 Summer</p>]]></description></item><item><title>Characteristics of Medicare persons in long-term care facilities.</title><pubDate>Mon, 04 Nov 2019 02:28:02 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191671</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191671</guid><description><![CDATA[<p>page_range: 175-180</p><p>primary_author: McCormick, John C</p><p>title: Characteristics of Medicare persons in long-term care facilities.</p><p>volume: 22</p><p>year_period: 2000 Winter</p>]]></description></item><item><title>BBA Impacts on Hospital Residents, Finances, and Medicare Subsidies</title><pubDate>Mon, 04 Nov 2019 02:28:02 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1205384</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1205384</guid><description><![CDATA[<p>page_range: 117-129</p><p>primary_author: Cromwell, J.</p><p>title: BBA Impacts on Hospital Residents, Finances, and Medicare Subsidies</p><p>volume: 28</p><p>year_period: 2006 Fall</p>]]></description></item><item><title>More Accurate Racial and Ethnic Codes for Medicare Administrative Data</title><pubDate>Mon, 04 Nov 2019 02:28:02 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1216280</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1216280</guid><description><![CDATA[<p>page_range: 27</p><p>primary_author: Eicheldinger, C.</p><p>title: More Accurate Racial and Ethnic Codes for Medicare Administrative Data</p><p>volume: Volume 29</p><p>year_period: 2008 Spring</p>]]></description></item><item><title>Medication Patterns for Medicare Beneficiaries with SNF / LTC Facility Stays</title><pubDate>Mon, 04 Nov 2019 02:28:02 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1216248</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1216248</guid><description><![CDATA[<p>page_range: 13</p><p>primary_author: Stuart, B.</p><p>title: Medication Patterns for Medicare Beneficiaries with SNF / LTC Facility Stays</p><p>volume: 29</p><p>year_period: 2008 Spring</p>]]></description></item><item><title>Evolution of quality review programs for Medicare: Quality assurance to quality improvement.</title><pubDate>Mon, 04 Nov 2019 02:28:02 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191651</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191651</guid><description><![CDATA[<p>abstract: This article outlines the development, successes, and future directions of the Medicare Peer Review Organizations (PRO) program. As established by the Tax Equity and Fiscal Responsibility Act of 1982, the purpose of the PRO program is to promote the quality, medical necessity, and appropriateness of services reimbursed through Medicare. We describe the evolution of the PRO program from a retrospective quality review approach, focused on individual events, to a proactive, quality improvement approach. Priorities for future development are described, including identification of additional clinical areas for attention, improvements in program infrastructure, and broadening the scope of projects to new provider settings.</p><p>authors: Blackstock, Sheila; Nelson, Rachel; Ng, Terry S</p><p>issue_mesh: Medicare : Quality Assurance, Health Care : Utilization Review : Aged : Program Evaluation : Quality of Health Care : Tax Equity and Fiscal Responsibility Act : United States : United States Health Care Financing Administration</p><p>issue_number: 1</p><p>ntis_number: PB2001-105913</p><p>page_range: 69-74</p><p>primary_author: Bhatia, Anita J</p><p>title: Evolution of quality review programs for Medicare: Quality assurance to quality improvement.</p><p>volume: 22</p><p>year_period: 2000 Fall</p>]]></description></item><item><title>Setting Physicians' Prices in FFS Medicare: An Economic Perspective</title><pubDate>Mon, 04 Nov 2019 02:28:02 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1205323</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1205323</guid><description><![CDATA[<p>page_range: 97-112</p><p>primary_author: Dowd, B.</p><p>title: Setting Physicians' Prices in FFS Medicare: An Economic Perspective</p><p>volume: 28</p><p>year_period: 2006 Winter</p>]]></description></item><item><title>Evaluation of Medicare Health Support Chronic Disease</title><pubDate>Mon, 04 Nov 2019 02:28:02 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1220338</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1220338</guid><description><![CDATA[<p>page_range: 47</p><p>primary_author: Cromwell, J.</p><p>title: Evaluation of Medicare Health Support Chronic Disease</p><p>volume: 30</p><p>year_period: 2008 Fall</p>]]></description></item><item><title>Origins and Elaboration of the National Health Accounts, 1926-2006</title><pubDate>Mon, 04 Nov 2019 02:28:02 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1205371</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1205371</guid><description><![CDATA[<p>page_range: 53-67</p><p>primary_author: Fetter, B.</p><p>title: Origins and Elaboration of the National Health Accounts, 1926-2006</p><p>volume: 28</p><p>year_period: 2006 Fall</p>]]></description></item><item><title>Health care for the poor: Medicaid at 35.</title><pubDate>Mon, 04 Nov 2019 02:28:02 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191646</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191646</guid><description><![CDATA[<p>abstract: Over its 35-year history, Medicaid has grown from a program to provide health insurance to the welfare population to one that provides health and long-term care (LTC) services to 40 million low-income families and elderly and disabled individuals. Despite its accomplishments in improving access to health care for low-income populations, Medicaid continues to face many challenges. The future of Medicaid as our Nation's health care safety net will be determined by Medicaid's ability to broaden health coverage for the low-income uninsured, secure access to quality care for its growing beneficiary population, and manage costs between the Federal and State governments.</p><p>authors: Garfield, Rachel</p><p>issue_mesh: Medicaid : Aged : Disabled Persons : Government : Health Services Accessibility : Insurance, Health : Long Term Care : Poverty : State Government : United States</p><p>issue_number: 1</p><p>ntis_number: PB2001-105913</p><p>page_range: 23-34</p><p>primary_author: Rowland, Diane</p><p>title: Health care for the poor: Medicaid at 35.</p><p>volume: 22</p><p>year_period: 2000 Fall</p>]]></description></item><item><title>Editorial Policy</title><pubDate>Mon, 04 Nov 2019 02:28:01 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1214696</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1214696</guid><description><![CDATA[<p>title: Editorial Policy</p><p>volume: N/A</p><p>year_period: 2007 Winter</p>]]></description></item><item><title>Health Based Capitation Risk Adjustment in Minnesota Public Health Care Programs</title><pubDate>Mon, 04 Nov 2019 02:28:01 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1214718</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1214718</guid><description><![CDATA[<p>page_range: 21-41</p><p>primary_author: Gifford, Gregory A.</p><p>title: Health Based Capitation Risk Adjustment in Minnesota Public Health Care Programs</p><p>volume: 26</p><p>year_period: 2004 Winter</p>]]></description></item><item><title>Personal Care Satisfaction Among Aged and Physically Disabled Medicaid Beneficiaries</title><pubDate>Mon, 04 Nov 2019 02:28:01 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1205372</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1205372</guid><description><![CDATA[<p>page_range: 69-86</p><p>primary_author: Khatutsky, G.</p><p>title: Personal Care Satisfaction Among Aged and Physically Disabled Medicaid Beneficiaries</p><p>volume: 28</p><p>year_period: 2006 Fall</p>]]></description></item><item><title>Medicaid Information Technology Architecture: An Overview</title><pubDate>Mon, 04 Nov 2019 02:28:01 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1205262</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1205262</guid><description><![CDATA[<p>page_range: 1-10</p><p>primary_author: Friedman, R. H.</p><p>title: Medicaid Information Technology Architecture: An Overview</p><p>volume: 28</p><p>year_period: 2006 Winter</p>]]></description></item><item><title>Redesigning Medicare Inpatient PPS to Adjust Payment for Post-Admission Complications</title><pubDate>Mon, 04 Nov 2019 02:28:01 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1205876</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1205876</guid><description><![CDATA[<p>page_range: 83-93</p><p>primary_author: Averill, R. F.</p><p>title: Redesigning Medicare Inpatient PPS to Adjust Payment for Post-Admission Complications</p><p>volume: 27</p><p>year_period: 2006 Spring</p>]]></description></item><item><title>Trends in the Health Status of Medicare Risk Contract Enrollees</title><pubDate>Mon, 04 Nov 2019 02:28:01 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1205322</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1205322</guid><description><![CDATA[<p>page_range: 81-96</p><p>primary_author: Riley, G.</p><p>title: Trends in the Health Status of Medicare Risk Contract Enrollees</p><p>volume: 28</p><p>year_period: 2006 Winter</p>]]></description></item><item><title>Access to Care for Disabled Children Under Medicaid</title><pubDate>Mon, 04 Nov 2019 02:28:01 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1214725</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1214725</guid><description><![CDATA[<p>page_range: 89-103</p><p>primary_author: Long, Sharon K.</p><p>title: Access to Care for Disabled Children Under Medicaid</p><p>volume: 26</p><p>year_period: 2004 Winter</p>]]></description></item><item><title>CMS Frailty Adjustment Model</title><pubDate>Mon, 04 Nov 2019 02:28:01 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1214717</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1214717</guid><description><![CDATA[<p>page_range: 1-19</p><p>primary_author: Kautter, John</p><p>title: CMS Frailty Adjustment Model</p><p>volume: 26</p><p>year_period: 2004 Winter</p>]]></description></item><item><title>Medicare Beneficiaries' Use of Computers and Internet: 1998-2005</title><pubDate>Mon, 04 Nov 2019 02:28:01 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1205267</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1205267</guid><description><![CDATA[<p>page_range: 45-52</p><p>primary_author: Tan, R. L.</p><p>title: Medicare Beneficiaries' Use of Computers and Internet: 1998-2005</p><p>volume: 28</p><p>year_period: 2006 Winter</p>]]></description></item><item><title>Trends and Current Drug Utilization Patterns of Medicaid Beneficiaries</title><pubDate>Mon, 04 Nov 2019 02:28:01 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1205881</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1205881</guid><description><![CDATA[<p>page_range: 123-132</p><p>primary_author: Lied, T. R.</p><p>title: Trends and Current Drug Utilization Patterns of Medicaid Beneficiaries</p><p>volume: 27</p><p>year_period: 2006 Spring</p>]]></description></item><item><title>Discussing Medicare Physician Productivity and the Exploratory Analysis</title><pubDate>Mon, 04 Nov 2019 02:28:01 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1214657</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1214657</guid><description><![CDATA[<p>page_range: 41-48</p><p>primary_author: Dyckman, Z.</p><p>title: Discussing Medicare Physician Productivity and the Exploratory Analysis</p><p>volume: 29</p><p>year_period: 2007 Winter</p>]]></description></item><item><title>Diabetes in the Medicare Aged Population, 2004</title><pubDate>Mon, 04 Nov 2019 02:28:01 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1216283</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1216283</guid><description><![CDATA[<p>page_range: 69</p><p>primary_author: Alder, G. S.</p><p>title: Diabetes in the Medicare Aged Population, 2004</p><p>volume: Volume 29</p><p>year_period: 2008 Spring</p>]]></description></item><item><title>Estimates of Physician Productivity: An Evaluation</title><pubDate>Mon, 04 Nov 2019 02:28:01 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1214656</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1214656</guid><description><![CDATA[<p>page_range: 33-40</p><p>primary_author: Newhouse, J. P.</p><p>title: Estimates of Physician Productivity: An Evaluation</p><p>volume: 29</p><p>year_period: 2007 Winter</p>]]></description></item><item><title>Overview of the SEER Medicare Health Outcomes Survey Linked Dataset</title><pubDate>Mon, 04 Nov 2019 02:28:01 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1216286</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1216286</guid><description><![CDATA[<p>page_range: 5</p><p>primary_author: Ambs, A.</p><p>title: Overview of the SEER Medicare Health Outcomes Survey Linked Dataset</p><p>volume: 29</p><p>year_period: 2008 Summer</p>]]></description></item><item><title>Hospital Multifactor Productivity: A Presentation and Analysis of Two Methodologies</title><pubDate>Mon, 04 Nov 2019 02:28:01 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1214658</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1214658</guid><description><![CDATA[<p>page_range: 49-64</p><p>primary_author: Cylus, J. D.</p><p>title: Hospital Multifactor Productivity: A Presentation and Analysis of Two Methodologies</p><p>volume: 29</p><p>year_period: 2007 Winter</p>]]></description></item><item><title>Medication Used Among Medicaid Users of Home and Community-Based Services</title><pubDate>Mon, 04 Nov 2019 02:28:01 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1205383</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1205383</guid><description><![CDATA[<p>page_range: 103-116</p><p>primary_author: Shinogle, J.</p><p>title: Medication Used Among Medicaid Users of Home and Community-Based Services</p><p>volume: 28</p><p>year_period: 2006 Fall</p>]]></description></item><item><title>Accuracy and Bias of Race/Ethnicity Codes in the Medicare Enrollment Database</title><pubDate>Mon, 04 Nov 2019 02:28:01 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1214720</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1214720</guid><description><![CDATA[<p>page_range: 61-72</p><p>primary_author: Waldo, Daniel R.</p><p>title: Accuracy and Bias of Race/Ethnicity Codes in the Medicare Enrollment Database</p><p>volume: 26</p><p>year_period: 2004 Winter</p>]]></description></item><item><title>Provider Opt Out Under Medicare Private Contracting</title><pubDate>Mon, 04 Nov 2019 02:28:01 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1214719</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1214719</guid><description><![CDATA[<p>page_range: 43-59</p><p>primary_author: Buczko, William</p><p>title: Provider Opt Out Under Medicare Private Contracting</p><p>volume: 26</p><p>year_period: 2004 Winter</p>]]></description></item><item><title>Role of SCHIP in Serving Children with Special Health Care Needs</title><pubDate>Mon, 04 Nov 2019 02:28:01 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1205268</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1205268</guid><description><![CDATA[<p>page_range: 53-64</p><p>primary_author: Yu, H.</p><p>title: Role of SCHIP in Serving Children with Special Health Care Needs</p><p>volume: 28</p><p>year_period: 2006 Winter</p>]]></description></item><item><title>Clinical Health Information Technologies and the Role of Medicaid</title><pubDate>Mon, 04 Nov 2019 02:28:01 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1205263</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1205263</guid><description><![CDATA[<p>page_range: 11-20</p><p>primary_author: Alfreds, S. T.</p><p>title: Clinical Health Information Technologies and the Role of Medicaid</p><p>volume: 28</p><p>year_period: 2006 Winter</p>]]></description></item><item><title>Medicaid Confronts a Changing Managed Care Marketplace</title><pubDate>Mon, 04 Nov 2019 02:28:00 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191718</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191718</guid><description><![CDATA[<p>page_range: 11-25</p><p>primary_author: Hurley, Robert</p><p>title: Medicaid Confronts a Changing Managed Care Marketplace</p><p>volume: 24</p><p>year_period: 2002 Fall</p>]]></description></item><item><title>Measuring beneficiary knowledge in two randomized experiments.</title><pubDate>Mon, 04 Nov 2019 02:28:00 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191698</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191698</guid><description><![CDATA[<p>page_range: 47-62</p><p>primary_author: McCormack, Lauren A</p><p>title: Measuring beneficiary knowledge in two randomized experiments.</p><p>volume: 23</p><p>year_period: 2001 Fall</p>]]></description></item><item><title>Monitoring Health Spending Increases: Incremental Budget Analyses reveal challenging Tradeoffs</title><pubDate>Mon, 04 Nov 2019 02:28:00 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1205368</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1205368</guid><description><![CDATA[<p>page_range: 41-52</p><p>primary_author: Hartman, M.</p><p>title: Monitoring Health Spending Increases: Incremental Budget Analyses reveal challenging Tradeoffs</p><p>volume: 28</p><p>year_period: 2006 Fall</p>]]></description></item><item><title>Randomized Trial of Stage-Based Interventions for Informed Medicare Choices</title><pubDate>Mon, 04 Nov 2019 02:28:00 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1205548</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1205548</guid><description><![CDATA[<p>page_range: 25-40</p><p>primary_author: Levesque, D. A.</p><p>title: Randomized Trial of Stage-Based Interventions for Informed Medicare Choices</p><p>volume: 27</p><p>year_period: 2006 Summer</p>]]></description></item><item><title>Voluntary Partial Capitation: The Community Nursing Organization Medicare Demonstration</title><pubDate>Mon, 04 Nov 2019 02:28:00 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1196852</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1196852</guid><description><![CDATA[<p>page_range: 21-38</p><p>primary_author: Frakt, A. B.,</p><p>title: Voluntary Partial Capitation: The Community Nursing Organization Medicare Demonstration</p><p>volume: 26</p><p>year_period: 2005 Summer</p>]]></description></item><item><title>Impact of Resource-Based Practice Expenses on the Medicare Physician Volume</title><pubDate>Mon, 04 Nov 2019 02:28:00 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1214665</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1214665</guid><description><![CDATA[<p>page_range: 65-80</p><p>primary_author: Maxwell, S.</p><p>title: Impact of Resource-Based Practice Expenses on the Medicare Physician Volume</p><p>volume: 29</p><p>year_period: 2007 Winter</p>]]></description></item><item><title>Low-Income Children's Preventive Services Use: Implications of Parents' Medicaid Status</title><pubDate>Mon, 04 Nov 2019 02:28:00 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1196932</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1196932</guid><description><![CDATA[<p>page_range: 81-94</p><p>primary_author: Glifford, E. J.</p><p>title: Low-Income Children's Preventive Services Use: Implications of Parents' Medicaid Status</p><p>volume: 26</p><p>year_period: 2005 Summer</p>]]></description></item><item><title>Medicare's Challenges in Paying Providers</title><pubDate>Mon, 04 Nov 2019 02:28:00 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1200182</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1200182</guid><description><![CDATA[<p>page_range: 35-44</p><p>primary_author: Newhouse, J. P.</p><p>title: Medicare's Challenges in Paying Providers</p><p>volume: 27</p><p>year_period: 2005 Winter</p>]]></description></item><item><title>Multifactor Productivity in Health Care</title><pubDate>Mon, 04 Nov 2019 02:28:00 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1214653</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1214653</guid><description><![CDATA[<p>page_range: 1-4</p><p>primary_author: Poisal, J. A.</p><p>title: Multifactor Productivity in Health Care</p><p>volume: 29</p><p>year_period: 2007 Winter</p>]]></description></item><item><title>Multifactor Productivity in Physicians' Offices: An Exploratory Analysis</title><pubDate>Mon, 04 Nov 2019 02:28:00 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1214655</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1214655</guid><description><![CDATA[<p>page_range: 15-32</p><p>primary_author: Fisher, C.</p><p>title: Multifactor Productivity in Physicians' Offices: An Exploratory Analysis</p><p>volume: 29</p><p>year_period: 2007 Winter</p>]]></description></item><item><title>Prescription Drug Use in the Elderly: A Descriptive Analysis</title><pubDate>Mon, 04 Nov 2019 02:28:00 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1214284</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1214284</guid><description><![CDATA[<p>page_range: 127-142</p><p>primary_author: Moxey, Elizabeth</p><p>title: Prescription Drug Use in the Elderly: A Descriptive Analysis</p><p>volume: 24</p><p>year_period: 2003 Summer</p>]]></description></item><item><title>Productivity Adjustment in the Medicare Physician Fee Schedule Update</title><pubDate>Mon, 04 Nov 2019 02:28:00 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1214654</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1214654</guid><description><![CDATA[<p>page_range: 5-14</p><p>primary_author: Newhouse, J. P.</p><p>title: Productivity Adjustment in the Medicare Physician Fee Schedule Update</p><p>volume: 29</p><p>year_period: 2007 Winter</p>]]></description></item><item><title>Return on Investment in Disease Management: A Review</title><pubDate>Mon, 04 Nov 2019 02:28:00 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1196851</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1196851</guid><description><![CDATA[<p>page_range: 1-19</p><p>primary_author: Goetzel, R.. Z.</p><p>title: Return on Investment in Disease Management: A Review</p><p>volume: 26</p><p>year_period: 2005 Summer</p>]]></description></item><item><title>U.S. and German Case Studies in Chronic Care Management: An Overview Care Management in Germany and</title><pubDate>Mon, 04 Nov 2019 02:28:00 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1198225</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1198225</guid><description><![CDATA[<p>page_range: 1-8</p><p>primary_author: Guterman, S.</p><p>title: U.S. and German Case Studies in Chronic Care Management: An Overview Care Management in Germany and</p><p>volume: 27</p><p>year_period: 2005 Fall</p>]]></description></item><item><title>Legislative Update</title><pubDate>Mon, 04 Nov 2019 02:28:00 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1214609</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1214609</guid><description><![CDATA[<p>page_range: 133-134</p><p>primary_author: N/A N/A</p><p>title: Legislative Update</p><p>volume: 20</p><p>year_period: 1998 Fall</p>]]></description></item><item><title>An overview: Expanding the women's health research frontier.</title><pubDate>Mon, 04 Nov 2019 02:28:00 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191683</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191683</guid><description><![CDATA[<p>page_range: 1-7</p><p>primary_author: Davenport, Marsha G</p><p>title: An overview: Expanding the women's health research frontier.</p><p>volume: 22</p><p>year_period: 2001 Summer</p>]]></description></item><item><title>Understanding and addressing racial disparities in health care</title><pubDate>Mon, 04 Nov 2019 02:28:00 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191642</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191642</guid><description><![CDATA[<p>page_range: 75-90</p><p>primary_author: Williams, David R</p><p>title: Understanding and addressing racial disparities in health care</p><p>volume: 21</p><p>year_period: 2000 Summer</p>]]></description></item><item><title>Medicaid Managed Care and Racial Disparities in AIDS Treatment</title><pubDate>Mon, 04 Nov 2019 02:28:00 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1214727</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1214727</guid><description><![CDATA[<p>page_range: 119-132</p><p>primary_author: Guwani, James M.</p><p>title: Medicaid Managed Care and Racial Disparities in AIDS Treatment</p><p>volume: 26</p><p>year_period: 2004 Winter</p>]]></description></item><item><title>Impact of expanding SSI on Medicaid expenditures of disabled children</title><pubDate>Mon, 04 Nov 2019 02:28:00 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191635</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191635</guid><description><![CDATA[<p>page_range: 185-201</p><p>primary_author: Ettner, Susan L</p><p>title: Impact of expanding SSI on Medicaid expenditures of disabled children</p><p>volume: 21</p><p>year_period: 2000 Spring</p>]]></description></item><item><title>Smoking Among Medicaid Insured Mothers: What are the Neonatal Expenses?</title><pubDate>Mon, 04 Nov 2019 02:28:00 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1214726</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1214726</guid><description><![CDATA[<p>page_range: 105-118</p><p>primary_author: Adams, E. Kathleen</p><p>title: Smoking Among Medicaid Insured Mothers: What are the Neonatal Expenses?</p><p>volume: 26</p><p>year_period: 2004 Winter</p>]]></description></item><item><title>Hospital union election activity, 1974-85.</title><pubDate>Mon, 04 Nov 2019 02:27:58 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192038</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192038</guid><description><![CDATA[<p>abstract: This study, using National Labor Relations Board data and American Hospital Association data, reports on the status of union election activity in the hospital industry for a 65-month period, January 1980-May 1985, and contrasts it with earlier data for a similar 65-month time period (1974-79). Together these data provide a comprehensive overview of union election activity in non-Federal, nongovernment hospitals since the passage of the 1974 Nonprofit Hospital Amendments to the Taft-Hartley Act. The study analyzes union, election, hospital, and environmental characteristics. Comparisons over the two time periods show that, while union victory rates in hospital elections have remained constant, the total number of elections has declined dramatically in the hospital industry.</p><p>authors: Rakich, Jonathon S</p><p>issue_mesh: Data Collection : Hospitals, Voluntary/manpower : Hospitals/manpower : Labor Unions/organization &#x26; administration : Personnel Administration, Hospital/trends : Politics : Support, U.S. Gov't, Non-P.H.S. : United States</p><p>issue_number: 3</p><p>ntis_number: PB88-218862</p><p>page_range: 59-66</p><p>primary_author: Becker, Edmund R</p><p>title: Hospital union election activity, 1974-85.</p><p>volume: 9</p><p>year_period: 1988 Spring</p>]]></description></item><item><title>Children's Servide Use During the Transition to PCCM in Two States</title><pubDate>Mon, 04 Nov 2019 02:27:58 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1197022</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1197022</guid><description><![CDATA[<p>page_range: 95-108</p><p>primary_author: Bronstein, J. M.</p><p>title: Children's Servide Use During the Transition to PCCM in Two States</p><p>volume: 26</p><p>year_period: 2005 Summer</p>]]></description></item><item><title>Adjusting capitation using chronic disease risk factors: a preliminary study.</title><pubDate>Mon, 04 Nov 2019 02:27:58 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192026</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192026</guid><description><![CDATA[<p>abstract: Researchers have sought ways to modify Medicare's capitation formula, the adjusted average per capita cost (AAPCC), by including measures of individual health status. The present study assesses the value of risk factors for disease as predictors of hospitalization for Framingham Heart Study participants (1,210 males and 1,496 females) 60-65 years of age. Regression models including several common physiologic measures and prior hospitalizations yielded adjusted R2s of 9.69 percent for males and 3.61 percent for females. The contributions of the risk factors and prior hospitalization were about equal and independent. These results confirm the potential utility of disease risk factors for adjusting the AAPCC.</p><p>authors: Belanger, Albert J; Crane, Stephen C; Stokes 3d, Joseph</p><p>issue_mesh: Capitation Fee : Fees and Charges : Actuarial Analysis : Aged : Chronic Disease/classification : Data Collection : Demography : Epidemiologic Methods : Health Maintenance Organizations/economics : Health Status : Hospitalization : Human : Massachusetts : Medicare/economics : Regression Analysis : Risk Factors : Statistics</p><p>issue_number: 2</p><p>ntis_number: PB88-196670</p><p>page_range: 15-23</p><p>primary_author: Howland, Jonathan</p><p>title: Adjusting capitation using chronic disease risk factors: a preliminary study.</p><p>volume: 9</p><p>year_period: 1987 Winter</p>]]></description></item><item><title>Medicare and Medicaid: The Past as Prologue</title><pubDate>Mon, 04 Nov 2019 02:27:58 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1199298</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1199298</guid><description><![CDATA[<p>page_range: 11-24</p><p>primary_author: Berkowitz, E.</p><p>title: Medicare and Medicaid: The Past as Prologue</p><p>volume: 27</p><p>year_period: 2005 Winter</p>]]></description></item><item><title>Case mix for nursing home payment: resource utilization groups, version II.</title><pubDate>Mon, 04 Nov 2019 02:27:58 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192055</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192055</guid><description><![CDATA[<p>ntis_number: PB89-188494</p><p>page_range: 39-52</p><p>primary_author: Schneider, Don P</p><p>title: Case mix for nursing home payment: resource utilization groups, version II.</p><p>volume: Supp.</p><p>year_period: 1988 Supp.</p>]]></description></item><item><title>Estimating Payment Error for Medicare Acute Care Inpatient Services</title><pubDate>Mon, 04 Nov 2019 02:27:58 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1196853</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1196853</guid><description><![CDATA[<p>page_range: 39-50</p><p>primary_author: Krushat, W. M.</p><p>title: Estimating Payment Error for Medicare Acute Care Inpatient Services</p><p>volume: 26</p><p>year_period: 2005 Summer</p>]]></description></item><item><title>Early experience of health maintenance organizations under Medicare competition demonstrations.</title><pubDate>Mon, 04 Nov 2019 02:27:58 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191996</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191996</guid><description><![CDATA[<p>abstract: Between 1982 and 1985, health maintenance organizations (HMO's) entered the Medicare market under the Medicare competition demonstrations. The status and experience of these HMO's, their market areas,, and the benefit packages they offered are presented. Information from case studies of 20 of these HMO's is used to discuss the planning process through which the organizations prepared to enter the Medicare market. Data from administrative reports, submitted by the HMO's, are used to describe the operational experience, including enrollments, utilization, and financial performance.</p><p>authors: Berman, Katherine; Brown, Randall S; Nelson, Lyle; Nelson, Shelly; Rossiter, Louis F</p><p>issue_mesh: Capitation Fee : Fees and Charges : Cost Control/methods : Evaluation Studies : Health Maintenance Organizations/organization &#x26; administration : Medicare/economics : Pilot Projects : Statistics : Support, U.S. Gov't, Non-P.H.S. : United States</p><p>issue_number: 3</p><p>ntis_number: PB88-131578</p><p>page_range: 37-55</p><p>primary_author: Langwell, Kathryn M</p><p>title: Early experience of health maintenance organizations under Medicare competition demonstrations.</p><p>volume: 8</p><p>year_period: 1987 Spring</p>]]></description></item><item><title>Budget Impact of Medicaid Section 1115 Demonstrations for Early HIV Treatment</title><pubDate>Mon, 04 Nov 2019 02:27:58 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1196891</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1196891</guid><description><![CDATA[<p>page_range: 67-80</p><p>primary_author: Shackman, B. R.</p><p>title: Budget Impact of Medicaid Section 1115 Demonstrations for Early HIV Treatment</p><p>volume: 26</p><p>year_period: 2005 Summer</p>]]></description></item><item><title>Children and Medicaid: the experience in four states.</title><pubDate>Mon, 04 Nov 2019 02:27:58 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192016</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192016</guid><description><![CDATA[<p>abstract: Medicaid coverage of children is analyzed in this article, using data from uniform Medicaid files (Tape-to-Tape) for California, Georgia, Michigan, and New York. Results show that Medicaid is a different program to children of different enrollment groups and ages. For children receiving cash assistance through either Aid to Families with Dependent Children or Supplemental Security Income, Medicaid represents a source of ongoing health coverage. However, for children in families not receiving cash assistance, coverage is more episodic and disproportionately related to acute care and hospitalization. Across all child enrollment groups, infants had higher than expected utilization and expenditures.</p><p>authors: Adler, Gerald S</p><p>issue_mesh: Aid to Families with Dependent Children/utilization : California : Child : Child Health Services/economics : Child, Preschool : Data Collection : Georgia : Health Policy : Human : Infant : Infant, Newborn : Medicaid/utilization : Michigan : New York : Statistics : Support, U.S. Gov't, Non-P.H.S.</p><p>issue_number: 1</p><p>ntis_number: PB88-160221</p><p>page_range: 1-20</p><p>primary_author: Rymer, Marilyn P</p><p>title: Children and Medicaid: the experience in four states.</p><p>volume: 9</p><p>year_period: 1987 Fall</p>]]></description></item><item><title>Is Case-Mix Adjustment Necessary for an Expanded Dialysis Bundle?</title><pubDate>Mon, 04 Nov 2019 02:27:58 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191752</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191752</guid><description><![CDATA[<p>page_range: 77-88</p><p>primary_author: Hirth, Richard</p><p>title: Is Case-Mix Adjustment Necessary for an Expanded Dialysis Bundle?</p><p>volume: 24</p><p>year_period: 2003 Summer</p>]]></description></item><item><title>End Stage Renal Disease and Medicare</title><pubDate>Mon, 04 Nov 2019 02:27:58 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191747</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191747</guid><description><![CDATA[<p>page_range: 1-5</p><p>primary_author: Greer, Joel</p><p>title: End Stage Renal Disease and Medicare</p><p>volume: 24</p><p>year_period: 2003 Summer</p>]]></description></item><item><title>Race and Ethnicity and the Identification of Special Needs Children</title><pubDate>Mon, 04 Nov 2019 02:27:58 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191709</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191709</guid><description><![CDATA[<p>page_range: 35-51</p><p>primary_author: Shenkman, Elizabeth</p><p>title: Race and Ethnicity and the Identification of Special Needs Children</p><p>volume: 23</p><p>year_period: 2001 Winter</p>]]></description></item><item><title>Health Care d Expenditures of Medicare HMO Disenrollees</title><pubDate>Mon, 04 Nov 2019 02:27:58 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1196573</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1196573</guid><description><![CDATA[<p>page_range: 31-44</p><p>primary_author: Parente, S. T.</p><p>title: Health Care d Expenditures of Medicare HMO Disenrollees</p><p>volume: 26</p><p>year_period: 2005 Spring</p>]]></description></item><item><title>HEDIS performance trends in Medicare managed care.</title><pubDate>Mon, 04 Nov 2019 02:27:58 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191705</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191705</guid><description><![CDATA[<p>page_range: 149-160</p><p>primary_author: Lied, Terry R</p><p>title: HEDIS performance trends in Medicare managed care.</p><p>volume: 23</p><p>year_period: 2001 Fall</p>]]></description></item><item><title>Financial Vulnerability Among Medicare Managed CareEnrollees</title><pubDate>Mon, 04 Nov 2019 02:27:58 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1196582</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1196582</guid><description><![CDATA[<p>page_range: 81-92</p><p>primary_author: Robbins, C. S.</p><p>title: Financial Vulnerability Among Medicare Managed CareEnrollees</p><p>volume: 26</p><p>year_period: 2005 Spring</p>]]></description></item><item><title>State-level variation in Medicare spending</title><pubDate>Mon, 04 Nov 2019 02:27:58 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191619</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191619</guid><description><![CDATA[<p>page_range: 85-98</p><p>primary_author: Gage, Barbara</p><p>title: State-level variation in Medicare spending</p><p>volume: 21</p><p>year_period: 1999 Winter</p>]]></description></item><item><title>Burden of Helath Care Costs: Businesses, Households, and Governments, 1987-2000</title><pubDate>Mon, 04 Nov 2019 02:27:58 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191711</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191711</guid><description><![CDATA[<p>page_range: 131-159</p><p>primary_author: Cowan, Cathy</p><p>title: Burden of Helath Care Costs: Businesses, Households, and Governments, 1987-2000</p><p>volume: 23</p><p>year_period: 2002 Spring</p>]]></description></item><item><title>Multiple Cohorts Analysis of the Medicare Health Outcomes Survey, 1998-2002</title><pubDate>Mon, 04 Nov 2019 02:27:58 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1196684</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1196684</guid><description><![CDATA[<p>page_range: 125-128</p><p>primary_author: Grace, S. C.</p><p>title: Multiple Cohorts Analysis of the Medicare Health Outcomes Survey, 1998-2002</p><p>volume: 26</p><p>year_period: 2005 Spring</p>]]></description></item><item><title>Estimating Medicare Advantage Lock-In Provisions Impacton Vulnerable Medicare Beneficiaries</title><pubDate>Mon, 04 Nov 2019 02:27:58 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1196576</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1196576</guid><description><![CDATA[<p>page_range: 63-80</p><p>primary_author: Laschober, M.</p><p>title: Estimating Medicare Advantage Lock-In Provisions Impacton Vulnerable Medicare Beneficiaries</p><p>volume: 26</p><p>year_period: 2005 Spring</p>]]></description></item><item><title>Evaluating the Effect of Translation on Spanish Speakers' Ratings of Medicare</title><pubDate>Mon, 04 Nov 2019 02:27:58 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1196885</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1196885</guid><description><![CDATA[<p>page_range: 51-66</p><p>primary_author: Bann, C. M.</p><p>title: Evaluating the Effect of Translation on Spanish Speakers' Ratings of Medicare</p><p>volume: 26</p><p>year_period: 2005 Summer</p>]]></description></item><item><title>Life care: new options for financing and delivering long-term care.</title><pubDate>Mon, 04 Nov 2019 02:27:57 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192070</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192070</guid><description><![CDATA[<p>ntis_number: PB89-188494</p><p>page_range: 139-143</p><p>primary_author: Cohen, Marc A</p><p>title: Life care: new options for financing and delivering long-term care.</p><p>volume: Supp.</p><p>year_period: 1988 Supp.</p>]]></description></item><item><title>Medicare elective surgery outcomes and state prospective reimbursement programs.</title><pubDate>Mon, 04 Nov 2019 02:27:57 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192010</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192010</guid><description><![CDATA[<p>ntis_number: PB89-136956</p><p>page_range: 17-27</p><p>primary_author: Gaumer, Gary L</p><p>title: Medicare elective surgery outcomes and state prospective reimbursement programs.</p><p>volume: Supp.</p><p>year_period: 1987 Supp.</p>]]></description></item><item><title>Physician participation in alternative health plans.</title><pubDate>Mon, 04 Nov 2019 02:27:57 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192046</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192046</guid><description><![CDATA[<p>abstract: In this article, physician participation in alternative health plans is examined, using cross-sectional data from the Physicians' Practice Costs and Income Survey, 1983-85. Overall, about one-third of physicians participated in one or more plans, ranging from 18 percent of general practitioners to 46 percent of medical subspecialists. Only 19 percent, however, received income from prepaid sources, averaging $5,275 per physician. Reasons for joining or not joining are also examined. Participants joined most often to maintain or increase workload, while nonparticipants most often declined to join because they would be giving up independence.</p><p>authors: Harrow, Brooke S; Hurdle, Sylvia</p><p>issue_mesh: Professional Practice : Professional Practice Location : Adult : Aged : Data Collection : Female : Health Maintenance Organizations/manpower : Human : Income : Independent Practice Associations/manpower : Insurance, Health/manpower : Male : Middle Age : Physicians/supply &#x26; distribution : Preferred Provider Organizations/manpower : Private Practice/manpower : Specialties, Medical : Statistics : Support, U.S. Gov't, Non-P.H.S. : United States</p><p>issue_number: 4</p><p>ntis_number: PB89-100663</p><p>page_range: 63-79</p><p>primary_author: Rosenbach, Margo L</p><p>title: Physician participation in alternative health plans.</p><p>volume: 9</p><p>year_period: 1988 Summer</p>]]></description></item><item><title>Use of specialty hospitals by Medicare beneficiaries, 1985.</title><pubDate>Mon, 04 Nov 2019 02:27:57 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192040</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192040</guid><description><![CDATA[<p>abstract: Information is provided on the use and cost of inpatient services for Medicare beneficiaries discharged from participating specialty hospitals during 1985. Specialty hospitals include: psychiatric, general long-term, rehabilitation, children's, alcohol and drug, and Christian Science sanatoriums. Specialty units of short-stay hospitals are not included in the specialty hospital data presented in this article.</p><p>authors: Latta, Viola B</p><p>issue_mesh: Insurance, Health, Reimbursement : Comparative Study : Data Collection : Disease/classification : Evaluation Studies : Hospitals, Special/utilization : Hospitals/utilization : Medicare/utilization : Statistics : United States</p><p>issue_number: 3</p><p>ntis_number: PB88-218862</p><p>page_range: 79-88</p><p>primary_author: Helbing, Charles</p><p>title: Use of specialty hospitals by Medicare beneficiaries, 1985.</p><p>volume: 9</p><p>year_period: 1988 Spring</p>]]></description></item><item><title>Community care demonstrations: what have we learned?</title><pubDate>Mon, 04 Nov 2019 02:27:57 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192006</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192006</guid><description><![CDATA[<p>abstract: Based on a review of community care demonstrations, we conclude that expanding public financing of community services beyond what already exists is likely to increase costs. Small nursing home cost reductions are more than offset by the increased costs of providing services to those who would remain at home even without the expanded services. However, expanded community services appear to make people better off and not to cause substantial reductions in family caregiving. Policymakers should move beyond asking whether expanding community care will reduce costs to addressing how much community care society is willing to pay for, who should receive it, and how it can be delivered efficiently.</p><p>authors: Applebaum, Robert; Harrigan, Margaret</p><p>issue_mesh: Community Health Services/economics : Costs and Cost Analysis : Evaluation Studies : Financing, Government/methods : Health Services Research/trends : Home Care Services/economics : Institutionalization/economics : Pilot Projects : Quality of Life : Statistics : Support, Non-U.S. Gov't : Support, U.S. Gov't, Non-P.H.S. : United States</p><p>issue_number: 4</p><p>ntis_number: PB88-131339</p><p>page_range: 87-100</p><p>primary_author: Kemper, Peter</p><p>title: Community care demonstrations: what have we learned?</p><p>volume: 8</p><p>year_period: 1987 Summer</p>]]></description></item><item><title>Evaluation of Arizona Health Care Cost Containment System, 1984-85.</title><pubDate>Mon, 04 Nov 2019 02:27:57 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192030</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192030</guid><description><![CDATA[<p>abstract: In this article, we describe the evaluation of the Arizona Health Care Cost Containment System (AHCCCS), Arizona's alternative to the acute care portion of Medicaid. We provide an assessment of implementation of the program's innovative features during its second 18 months of operation, from April 1984 through September 1985. Included in the evaluation are assessments of the administration of the program, provider relations, eligibility, enrollment and marketing, information systems, quality assurance and member satisfaction activities, the relationship of the county governments to AHCCCS, the competitive bidding process, and the plans and their financial status.</p><p>authors: Crane, Michael; Freund, Deborah A; Haber, Susan; Henton, Douglas; Paringer, Lynn; Wrightson, William</p><p>issue_mesh: Delivery of Health Care : Government : Managed Care Programs : State Government : Arizona : Cost Control : Data Collection : Evaluation Studies : Hospitals : Human : Medicaid/organization &#x26; administration : Medical Indigency</p><p>issue_number: 2</p><p>ntis_number: PB88-196670</p><p>page_range: 79-89</p><p>primary_author: McCall, Nelda</p><p>title: Evaluation of Arizona Health Care Cost Containment System, 1984-85.</p><p>volume: 9</p><p>year_period: 1987 Winter</p>]]></description></item><item><title>Long-term care: the public role and the private initiatives.</title><pubDate>Mon, 04 Nov 2019 02:27:57 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192051</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192051</guid><description><![CDATA[<p>ntis_number: PB89-188494</p><p>page_range: 1-6</p><p>primary_author: Burke, Thomas R</p><p>title: Long-term care: the public role and the private initiatives.</p><p>volume: Supp.</p><p>year_period: 1988 Supp.</p>]]></description></item><item><title>Physician utilization and expenditures in a Medicaid population.</title><pubDate>Mon, 04 Nov 2019 02:27:57 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191986</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191986</guid><description><![CDATA[<p>abstract: The determinants of physician visit utilization and expenditures for the full-year Medicaid enrollees in the State Medicaid household survey portion of the National Medical Care Utilization and Expenditure Survey are analyzed in this article. The regression analyses for the probability of a physician visit, for number of physician visits, and for physician visit expenditures underscore the importance of perceived health status as a determinant of both physician utilization and expenditures. Other important determinants of physician utilization and expenditures were regular source of care, State, enrollment group, sex, and family size.</p><p>authors: N/A</p><p>issue_mesh: Physicians : Data Collection : Health Expenditures : Health Status : Medicaid/utilization : Office Visits : Personal Health Services/utilization : Probability : Regression Analysis : Socioeconomic Factors : Statistics : United States</p><p>issue_number: 2</p><p>ntis_number: PB88-131586</p><p>page_range: 17-26</p><p>primary_author: Buczko, William</p><p>title: Physician utilization and expenditures in a Medicaid population.</p><p>volume: 8</p><p>year_period: 1986 Winter</p>]]></description></item><item><title>Case management in the social health maintenance organization demonstrations.</title><pubDate>Mon, 04 Nov 2019 02:27:57 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192060</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192060</guid><description><![CDATA[<p>ntis_number: PB89-188494</p><p>page_range: 83-88</p><p>primary_author: Yordi, Cathleen L</p><p>title: Case management in the social health maintenance organization demonstrations.</p><p>volume: Supp.</p><p>year_period: 1988 Supp.</p>]]></description></item><item><title>Medicare enrollment in health maintenance organizations.</title><pubDate>Mon, 04 Nov 2019 02:27:57 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192000</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192000</guid><description><![CDATA[<p>authors: Lubitz, James; Russell, Delores</p><p>issue_mesh: Tax Equity and Fiscal Responsibility Act : Taxes : Data Collection : Health Maintenance Organizations/utilization : Medicare/utilization : Statistics : United States</p><p>issue_number: 3</p><p>ntis_number: PB88-131578</p><p>page_range: 87-93</p><p>primary_author: McMillan, Alma</p><p>title: Medicare enrollment in health maintenance organizations.</p><p>volume: 8</p><p>year_period: 1987 Spring</p>]]></description></item><item><title>Case management in capitated long-term care.</title><pubDate>Mon, 04 Nov 2019 02:27:57 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192059</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192059</guid><description><![CDATA[<p>ntis_number: PB89-188494</p><p>page_range: 75-81</p><p>primary_author: Zawadski, Rick T</p><p>title: Case management in capitated long-term care.</p><p>volume: Supp.</p><p>year_period: 1988 Supp.</p>]]></description></item><item><title>Comparative trends in hospital expenses, finances, utilization, and inputs, 1970-81.</title><pubDate>Mon, 04 Nov 2019 02:27:57 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192020</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192020</guid><description><![CDATA[<p>abstract: The annual surveys of the American Hospital Association historically have been only national source of statistics on hospital structure and performance. Although valuable, this source has not provided the policy or research community with hospital-specific information on revenues, assets, and financial status. Data on these and other variables from heretofore unpublished Medicare cost report data are presented in this article. Hospital expenses, revenues, profits, indebtedness, utilization, investments, and employees are trended over the 1970-81 period by urban-rural location, teaching status, and ownership. It is indicated in these data that a major transformation in the hospital industry has occurred in response to cost-based Medicare-Medicaid and other factors that made acute care essentially unaffordable to the average citizen. The health maintenance organization movement and Medicare's prospective payment system are seen as logical reactions to this transformation.</p><p>authors: Franklin, Saul; Hewes, Helene T; Kelly, Nancy L</p><p>issue_mesh: Data Collection : Economics, Hospital/trends : Financial Management, Hospital/trends : Health Expenditures/trends : Hospitals/utilization : Income : Medicare/economics : Statistics : Support, U.S. Gov't, Non-P.H.S. : United States</p><p>issue_number: 1</p><p>ntis_number: PB88-160221</p><p>page_range: 51-69</p><p>primary_author: Cromwell, Jerry L</p><p>title: Comparative trends in hospital expenses, finances, utilization, and inputs, 1970-81.</p><p>volume: 9</p><p>year_period: 1987 Fall</p>]]></description></item><item><title>Utilization and case-mix impacts of per case payment in Maryland.</title><pubDate>Mon, 04 Nov 2019 02:27:57 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192035</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192035</guid><description><![CDATA[<p>abstract: Maryland has simultaneously operated per case and per service hospital payment systems since 1976 with varying levels of stringency in setting per case rates. Regression analyses of this experience are used to compare the impacts of these systems on admissions, length of stay, and case-mix costliness from July 1, 1976 to June 30, 1981. Our results indicate a positive effect on admissions and negative effects on case mix and length of stay for the per case payment approach relative to the per service approach. More stringent levels of per case payment are associated with stronger utilization responses.</p><p>authors: Steinwachs, Donald M</p><p>issue_mesh: Reimbursement Mechanisms : Data Collection : Diagnosis-Related Groups/economics : Hospitals/utilization : Length of Stay/economics : Maryland : Medicare/organization &#x26; administration : Patient Admission/economics : Rate Setting and Review/methods : Regression Analysis : Statistics : Support, U.S. Gov't, P.H.S.</p><p>issue_number: 3</p><p>ntis_number: PB88-218862</p><p>page_range: 23-32</p><p>primary_author: Salkever, David S</p><p>title: Utilization and case-mix impacts of per case payment in Maryland.</p><p>volume: 9</p><p>year_period: 1988 Spring</p>]]></description></item><item><title>Status of the Medicaid competition demonstrations.</title><pubDate>Mon, 04 Nov 2019 02:27:57 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191991</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191991</guid><description><![CDATA[<p>abstract: In 1982, the Health Care Financing Administration approved funding for demonstration programs in six States to test a variety of alternative delivery strategies for Medicaid recipients. A number of innovative health service delivery features have been used in these programs, including competition, capitation, case management, and limitations on provider choice. These strategies have been tried in order to address the key Medicaid problems of cost containment and access to appropriate and high quality care. This article provides an overview of how the demonstration sites have approached the task of designing, developing, and implementing their various programs.</p><p>authors: N/A</p><p>issue_mesh: Economic Competition : Economics : Health Services Research : Cost-Benefit Analysis : Medicaid/organization &#x26; administration : Pilot Projects : State Government : Support, U.S. Gov't, Non-P.H.S. : United States : United States Health Care Financing Administration</p><p>issue_number: 2</p><p>ntis_number: PB88-131586</p><p>page_range: 65-75</p><p>primary_author: Hurley, Robert E</p><p>title: Status of the Medicaid competition demonstrations.</p><p>volume: 8</p><p>year_period: 1986 Winter</p>]]></description></item><item><title>Health care facilities participating in Medicare and Medicaid programs, 1987.</title><pubDate>Mon, 04 Nov 2019 02:27:57 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192032</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192032</guid><description><![CDATA[<p>authors: Kirby, Will</p><p>issue_mesh: Data Collection : Health Facilities/classification : Human : Medicaid/utilization : Medicare/utilization : Statistics : United States : United States Health Care Financing Administration</p><p>issue_number: 2</p><p>ntis_number: PB88-196670</p><p>page_range: 101-105</p><p>primary_author: Watkins, Valeria</p><p>title: Health care facilities participating in Medicare and Medicaid programs, 1987.</p><p>volume: 9</p><p>year_period: 1987 Winter</p>]]></description></item><item><title>Simulating the impact of case-mix adjusted hospice rates.</title><pubDate>Mon, 04 Nov 2019 02:27:57 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191990</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191990</guid><description><![CDATA[<p>abstract: The Medicare hospice benefit prospectively reimburses hospices based on the inpatient status of the patient, whether or not the patient is at home, and whether the patient is receiving round-the-clock nursing. Using national Hospice Study data, two case-mix adjusters based on patient functioning and living arrangement were found to be significantly related to per diem cost. These were tested by simulating their impact on hospice revenues. Increasing per diem reimbursements 35 percent for nonambulatory patients living alone only increases hospice revenues by 4 percent; hospices with sicker patients benefit the most.</p><p>authors: Laliberte, Linda</p><p>issue_mesh: Analysis of Variance : Costs and Cost Analysis : Data Collection : Diagnosis-Related Groups/economics : Feasibility Studies : Hospices/economics : Income : Length of Stay/economics : Medicare/economics : Prospective Payment System/methods : Socioeconomic Factors : Statistics : United States : United States Health Care Financing Administration</p><p>issue_number: 2</p><p>ntis_number: PB88-131586</p><p>page_range: 53-64</p><p>primary_author: Mor, Vincent</p><p>title: Simulating the impact of case-mix adjusted hospice rates.</p><p>volume: 8</p><p>year_period: 1986 Winter</p>]]></description></item><item><title>Physician charges for surgical services under Medicare, by medical specialty: 1980 and 1985.</title><pubDate>Mon, 04 Nov 2019 02:27:57 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192050</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192050</guid><description><![CDATA[<p>abstract: Since 1980, a number of Medicare practice and utilization patterns have changed as a result of payment reform, certification of new types of providers, and changes in technology. The shift in physician surgical charges by specialty and by setting is examined in this article.</p><p>authors: N/A</p><p>issue_mesh: Ambulatory Surgical Procedures/economics : Comparative Study : Data Collection : Health Expenditures/trends : Insurance, Health/utilization : Insurance, Surgical/utilization : Medicare/utilization : Specialties, Surgical/economics : Statistics : United States</p><p>issue_number: 4</p><p>ntis_number: PB89-100663</p><p>page_range: 127-132</p><p>primary_author: Fisher, Charles R</p><p>title: Physician charges for surgical services under Medicare, by medical specialty: 1980 and 1985.</p><p>volume: 9</p><p>year_period: 1988 Summer</p>]]></description></item><item><title>State Medicaid reimbursement for nursing homes, 1978-86.</title><pubDate>Mon, 04 Nov 2019 02:27:57 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192036</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192036</guid><description><![CDATA[<p>abstract: State Medicaid reimbursement methods and rates are reported for the period 1978-86 for skilled nursing and intermediate care facilities. A cross-sectional time series regression analysis of Medicaid reimbursement rates on methods showed that States using prospective class reimbursement had significantly lower rates for the period 1982-86. States using prospective facility-specific reimbursement methods had lower rates than retrospective methods in 1983-84.</p><p>authors: Grant, Leslie A; Harrington, Charlene</p><p>issue_mesh: Reimbursement Mechanisms : Data Collection : Evaluation Studies : Intermediate Care Facilities/economics : Medicaid/organization &#x26; administration : Nursing Homes/economics : Rate Setting and Review/methods : Regression Analysis : Skilled Nursing Facilities/economics : State Government : Support, U.S. Gov't, Non-P.H.S. : United States</p><p>issue_number: 3</p><p>ntis_number: PB88-218862</p><p>page_range: 33-50</p><p>primary_author: Swan, James H</p><p>title: State Medicaid reimbursement for nursing homes, 1978-86.</p><p>volume: 9</p><p>year_period: 1988 Spring</p>]]></description></item><item><title>Home equity conversion and the financing of long-term care.</title><pubDate>Mon, 04 Nov 2019 02:27:57 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192065</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192065</guid><description><![CDATA[<p>ntis_number: PB89-188494</p><p>page_range: 113-115</p><p>primary_author: Weinrobe, Maurice D</p><p>title: Home equity conversion and the financing of long-term care.</p><p>volume: Supp.</p><p>year_period: 1988 Supp.</p>]]></description></item><item><title>Update on provider input price indexes.</title><pubDate>Mon, 04 Nov 2019 02:27:57 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192041</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192041</guid><description><![CDATA[<p>authors: N/A</p><p>issue_mesh: Abstracting and Indexing : Economics : Inflation, Economic : Economics, Hospital/trends : Home Care Services/economics : Medicare/economics : Models, Theoretical : Prospective Payment System/economics : Skilled Nursing Facilities/economics : Statistics : United States</p><p>issue_number: 3</p><p>ntis_number: PB88-218862</p><p>page_range: 89-94</p><p>primary_author: Cymer, William E</p><p>title: Update on provider input price indexes.</p><p>volume: 9</p><p>year_period: 1988 Spring</p>]]></description></item><item><title>Medicare's common denominator: the covered population.</title><pubDate>Mon, 04 Nov 2019 02:27:56 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191593</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191593</guid><description><![CDATA[<p>abstract: This report describes Medicare eligibility requirements: the processes to establish Medicare entitlement; types of coverage; the composition of the enrolled population; and outlines some differences in measurement techniques used in a decennial census in contrast to Medicaid enrollment. Current Medicare enrollment figures do not represent a complete count of any segment of the total United States population. Some persons age 65 and over are not eligible for Medicare; others are eligible but not entitled. However, the Medicare enrollment figures are frequently used as surrogate counts of the aged population because they provide excellent sources of detailed demographic and geographic information for a large proportion of those age 65 and over. The data are produced semi-annually, based on daily updates.</p><p>authors: N/A</p><p>issue_mesh: Eligibility Determination : Aged : Demography : Human : Medicare/utilization : Statistics : United States</p><p>issue_number: 2</p><p>ntis_number: HRP-0902942</p><p>page_range: 53-64</p><p>primary_author: Hatten, James M</p><p>title: Medicare's common denominator: the covered population.</p><p>volume: 2</p><p>year_period: 1980 Fall</p>]]></description></item><item><title>The role of payment source in differentiating nursing home residents, services, and payments.</title><pubDate>Mon, 04 Nov 2019 02:27:56 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191587</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191587</guid><description><![CDATA[<p>abstract: In 1976, it cost $10.6 billion to care for the over one million nursing home residents in the U.S. (Gibson et al, 1977). While public and private sources spent almost equal amounts, it is widely believed that differences exist between public and private patients in terms of need for institutionalization, services received, and rates of payment for care. This paper presents a descriptive analysis of data from a national probability survey, the 1976 Survey of Institutionalized Persons (SIP), and examines variations associated with source of payment for institutionalized long-term care.</p><p>authors: Mossey, Jana</p><p>issue_mesh: Activities of Daily Living : Aged : Analysis of Variance : Health Services Accessibility/economics : Human : Nursing Homes/economics : Quality of Health Care/economics : United States</p><p>issue_number: 1</p><p>ntis_number: PB81-112823</p><p>page_range: 51-61</p><p>primary_author: Liu, Korbin</p><p>title: The role of payment source in differentiating nursing home residents, services, and payments.</p><p>volume: 2</p><p>year_period: 1980 Summer</p>]]></description></item><item><title>Home-Care Use and Expenditures Among Medicaid Beneficiaries with AIDS</title><pubDate>Mon, 04 Nov 2019 02:27:56 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191582</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191582</guid><description><![CDATA[<p>abstract: This article compares the use and cost of home-care services among traditional Medicaid recipients with acquired immunodeficiency syndrome (AIDS) and among participants in a statewide Human Immunodeficiency Virus (HIV)/AIDS-specific home and community-based Medicaid waiver program in New Jersey, using Medicaid claims and AIDS surveillance data. Waiver program participation appears to mitigate racial and risk group differences in the probability of home-care use. However, the program s successes are confined to its enrollees of which subgroups of the AIDS population are underrepresented. Our findings suggest the need to expand access to home-care programs to racial minorities and injection drug users (IDUs) with HIV/AIDS.</p><p>authors: Collins, Sara R; Crystal, Stephen; Walkup, James</p><p>issue_mesh: Home Care Services/utilization : Acquired Immunodeficiency Syndrome/economics : Community Health Services/utilization : Medicaid : Minority Groups : Multivariate Analysis : New Jersey : Support, U.S. Gov't, non-P.H.S. : United States</p><p>issue_number: 4</p><p>ntis_number: PB2000-102444</p><p>page_range: 161-177</p><p>primary_author: Sambamoorthi, Usha</p><p>title: Home-Care Use and Expenditures Among Medicaid Beneficiaries with AIDS</p><p>volume: 20</p><p>year_period: 1999 Summer</p>]]></description></item><item><title>Cost and outcomes of Medicare reimbursement for HMO preventive services</title><pubDate>Mon, 04 Nov 2019 02:27:56 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191575</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191575</guid><description><![CDATA[<p>abstract: Medicare beneficiaries enrolled in a health maintenance organization (HMO) were randomized to a preventive services benefit package for 2 years or to usual care. At 24- and 48-month followups, the treatment group had completed more advance directives, participated in more exercise, and consumed less dietary fat than the control group. Unexpectedly, more deaths occurred in the treatment group. Surviving treatment-group enrollees reported higher satisfaction with health, less decline in self-rated health status, and fewer depressive symptoms than surviving control participants. Despite these changes, the intervention did not yield lower cost per quality-adjusted life year in this historically prevention-oriented HMO.</p><p>authors: Beery, William; Beresford, Shirley A; Diehr, Paula; Durham, Mary; Ehreth, Jenifer; Grembowski, David; Hecht, Julia; Picciano, Joe</p><p>issue_mesh: Case Management : Health Expenditures : Health Maintenance Organizations : Program Evaluation : Aged : Data Collection : Evaluation Studies : Health Status : Medicare/economics/utilization : Questionnaire : Support, U.S. Gov't, non-P.H.S. : United States</p><p>issue_number: 4</p><p>ntis_number: PB2000-102444</p><p>page_range: 25-43</p><p>primary_author: Patrick, Donald L</p><p>title: Cost and outcomes of Medicare reimbursement for HMO preventive services</p><p>volume: 20</p><p>year_period: 1999 Summer</p>]]></description></item><item><title>Case management for high-cost Medicare beneficiaries</title><pubDate>Mon, 04 Nov 2019 02:27:56 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191578</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191578</guid><description><![CDATA[<p>abstract: We estimated the effects of three Health Care Financing Administration (HCFA)-funded case management demonstrations for high-cost Medicare beneficiaries in the fee-for-service (FFS) sector. Participating beneficiaries were randomly assigned to receive case management plus regular Medicare benefits or regular benefits only. None of the demonstrations improved self-care or health or reduced Medicare spending. Despite the lack of effects of these interventions, case management might be cost-effective if it includes greater involvement of physicians, is more well-defined and goal-oriented, and incorporates financial incentives to generate savings in Medicare costs. Models incorporating these changes should be investigated before abandoning Medicare case management interventions.</p><p>authors: Brown, Randall S; Cheh, Valerie A</p><p>issue_mesh: Case Management : Program Evaluation : Aged : Data Collection : Medicare : Regression Analysis : Support, U.S. Gov't, non-P.H.S. : United States</p><p>issue_number: 4</p><p>ntis_number: PB2000-102444</p><p>page_range: 87-101</p><p>primary_author: Schore, Jennifer L</p><p>title: Case management for high-cost Medicare beneficiaries</p><p>volume: 20</p><p>year_period: 1999 Summer</p>]]></description></item><item><title>Impact of municipal health services Medicare waiver program.</title><pubDate>Mon, 04 Nov 2019 02:27:56 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191994</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191994</guid><description><![CDATA[<p>abstract: A major goal of the municipal health services program (MHSP) was improvement of health services for the elderly while containing Medicare reimbursement. A Health Care Financing Administration financed Medicare waiver program provided some additional benefits to Medicare Part B enrollees who used the MHSP clinics. Disadvantaged and sicker elderly groups were underrepresented in MHSP facilities. However, even after taking these differences between MHSP and other patients into account, analyses of Medicare records showed that participants in this program had lower reimbursement for hospital inpatient, outpatient, and emergency room services. Also, participants had higher reimbursements for physicians' ambulatory and ancillary care. The net result was total Medicare reimbursements were decreased for program participants.</p><p>authors: Andersen, Ronald M; Champney, Timothy F; Hausner, Tony; Lyttle, Christopher S</p><p>issue_mesh: Health : Reimbursement Mechanisms : Urban Health : Aged : Community Health Services/economics : Cost Control/methods : Data Collection : Evaluation Studies : Human : Medicare/economics : Pilot Projects : Support, Non-U.S. Gov't : Support, U.S. Gov't, Non-P.H.S. : United States</p><p>issue_number: 3</p><p>ntis_number: PB88-131578</p><p>page_range: 13-25</p><p>primary_author: Fleming, Gretchen V</p><p>title: Impact of municipal health services Medicare waiver program.</p><p>volume: 8</p><p>year_period: 1987 Spring</p>]]></description></item><item><title>From Clinical records to Regulatory Reporting: Formal Terminologies as Foundation</title><pubDate>Mon, 04 Nov 2019 02:27:56 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191744</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191744</guid><description><![CDATA[<p>page_range: 103-120</p><p>primary_author: Harris, Marcelline</p><p>title: From Clinical records to Regulatory Reporting: Formal Terminologies as Foundation</p><p>volume: 24</p><p>year_period: 2003 Spring</p>]]></description></item><item><title>Medicare use and cost of short-stay hospital services by enrollees with cataract, 1984.</title><pubDate>Mon, 04 Nov 2019 02:27:56 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192031</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192031</guid><description><![CDATA[<p>abstract: In this article, we present data on aged and disabled Medicare hospital insurance enrollees discharged with the principal diagnosis of cataract from short-stay hospitals. Medical technology has reduced the risk of cataract surgery and the time needed to perform the surgery. As a result, the number of enrollees undergoing cataract surgery has increased. Also, such surgery has been shifted from inpatient hospitals to outpatient facilities. However, outpatient reimbursement for cataract surgery often equals or exceeds inpatient payments. To address this inequity, Congress legislated payment limits for cataract surgery.</p><p>authors: Black, Cheryl</p><p>issue_mesh: Aged : Aged, 80 and over : Cataract Extraction/economics : Data Collection : Disabled Persons : Female : Human : Insurance, Hospitalization/utilization : Male : Medicare/utilization : Patient Discharge/economics : Statistics : United States : United States Health Care Financing Administration</p><p>issue_number: 2</p><p>ntis_number: PB88-196670</p><p>page_range: 91-99</p><p>primary_author: Ruther, Martin M</p><p>title: Medicare use and cost of short-stay hospital services by enrollees with cataract, 1984.</p><p>volume: 9</p><p>year_period: 1987 Winter</p>]]></description></item><item><title>Quality of Life and Patient Satisfaction: ESRD Managed Care Demonstration</title><pubDate>Mon, 04 Nov 2019 02:27:56 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191750</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191750</guid><description><![CDATA[<p>page_range: 45-58</p><p>primary_author: N/A, N/A</p><p>title: Quality of Life and Patient Satisfaction: ESRD Managed Care Demonstration</p><p>volume: 24</p><p>year_period: 2003 Summer</p>]]></description></item><item><title>Market Entry and Exit in Long-Term Care: 1985-2000</title><pubDate>Mon, 04 Nov 2019 02:27:56 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191730</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191730</guid><description><![CDATA[<p>page_range: 17-32</p><p>primary_author: Dalton, Kathleen</p><p>title: Market Entry and Exit in Long-Term Care: 1985-2000</p><p>volume: 24</p><p>year_period: 2002 Winter</p>]]></description></item><item><title>Prospective payment system and quality: early results and research strategy.</title><pubDate>Mon, 04 Nov 2019 02:27:56 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192011</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192011</guid><description><![CDATA[<p>ntis_number: PB89-136956</p><p>page_range: 29-37</p><p>primary_author: Eggers, Paul W</p><p>title: Prospective payment system and quality: early results and research strategy.</p><p>volume: Supp.</p><p>year_period: 1987 Supp.</p>]]></description></item><item><title>Respite care: lessons from a controlled design study.</title><pubDate>Mon, 04 Nov 2019 02:27:56 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192069</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192069</guid><description><![CDATA[<p>ntis_number: PB89-188494</p><p>page_range: 133-138</p><p>primary_author: Montgomery, Rhonda J</p><p>title: Respite care: lessons from a controlled design study.</p><p>volume: Supp.</p><p>year_period: 1988 Supp.</p>]]></description></item><item><title>A descriptive framework for new hospital roles in geriatric care.</title><pubDate>Mon, 04 Nov 2019 02:27:55 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192053</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192053</guid><description><![CDATA[<p>ntis_number: PB89-188494</p><p>page_range: 17-25</p><p>primary_author: Capitman, John A</p><p>title: A descriptive framework for new hospital roles in geriatric care.</p><p>volume: Supp.</p><p>year_period: 1988 Supp.</p>]]></description></item><item><title>Nursing home regulation: history and expectations.</title><pubDate>Mon, 04 Nov 2019 02:27:55 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192068</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192068</guid><description><![CDATA[<p>ntis_number: PB89-188494</p><p>page_range: 129-132</p><p>primary_author: Morford, Thomas G</p><p>title: Nursing home regulation: history and expectations.</p><p>volume: Supp.</p><p>year_period: 1988 Supp.</p>]]></description></item><item><title>Assessing process of care under capitated and fee-for-service Medicare.</title><pubDate>Mon, 04 Nov 2019 02:27:55 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192014</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192014</guid><description><![CDATA[<p>ntis_number: PB89-136956</p><p>page_range: 57-68</p><p>primary_author: Bates, Elizabeth W</p><p>title: Assessing process of care under capitated and fee-for-service Medicare.</p><p>volume: Supp.</p><p>year_period: 1987 Supp.</p>]]></description></item><item><title>Nursing home bed capacity in the States, 1978-86.</title><pubDate>Mon, 04 Nov 2019 02:27:55 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192047</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192047</guid><description><![CDATA[<p>abstract: Trends in nursing home bed supply in the States show large variations in beds per population and a gradual decline in supply per aged population. A cross-sectional time-series regression analysis was used to examine some factors associated with nursing home bed supply. Variation was accounted for by economic factors, supply of alternative services, and climate. State Medicaid reimbursement rates had negative coefficients, with supply suggesting States may be increasing rates to improve access where supply is limited. Medicaid waiver policy was not found to be significant.</p><p>authors: Grant, Leslie A; Swan, James H</p><p>issue_mesh: Data Collection : Health Services Needs and Demand/trends : Health Services Research/trends : Hospitals : Intermediate Care Facilities/supply &#x26; distribution : Medicaid/utilization : Nursing Homes/supply &#x26; distribution : Regression Analysis : Skilled Nursing Facilities/supply &#x26; distribution : State Government : Statistics : United States</p><p>issue_number: 4</p><p>ntis_number: PB89-100663</p><p>page_range: 81-97</p><p>primary_author: Harrington, Charlene</p><p>title: Nursing home bed capacity in the States, 1978-86.</p><p>volume: 9</p><p>year_period: 1988 Summer</p>]]></description></item><item><title>Low-birth-weight rate reduced by the obstetrical access project.</title><pubDate>Mon, 04 Nov 2019 02:27:55 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191999</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191999</guid><description><![CDATA[<p>abstract: Obstetrical (OB) access was a Medicaid pilot project that operated in 13 California counties from July 1979 through June 1982. The project goals were to both improve access to care in underserved areas and improve pregnancy outcomes by providing enhanced prenatal care, including psychosocial, health education, and nutrition services. The project registered 6,774 women. The findings were: 87 percent of the registrants started prenatal care during the first or second trimester; 84 percent of the registrants completed care in the project; OB access mothers had a low-birth-weight rate of 4.7 percent, compared with 7.0 percent for a matched control group, suggesting a 33-percent reduction in low birth weight through the project; and the benefit-cost ratio of this program was about 2 to 1 for the short run because of savings in neonatal intensive care services. The State of California approved legislation in 1984 authorizing the project's scope of services for the Medi-Cal recipients on a statewide basis.</p><p>authors: Hausner, Tony; Klun, Joseph R</p><p>issue_mesh: Health Services Accessibility : Outcome and Process Assessment (Health Care) : California : Data Collection : Female : Human : Infant, Low Birth Weight : Infant, Newborn : Medicaid/economics : Pilot Projects : Pregnancy : Prenatal Care/economics</p><p>issue_number: 3</p><p>ntis_number: PB88-131578</p><p>page_range: 83-86</p><p>primary_author: Lennie, J Athole</p><p>title: Low-birth-weight rate reduced by the obstetrical access project.</p><p>volume: 8</p><p>year_period: 1987 Spring</p>]]></description></item><item><title>Medicaid Tape-to-Tape findings: California, New York, and Michigan, 1981.</title><pubDate>Mon, 04 Nov 2019 02:27:55 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192042</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192042</guid><description><![CDATA[<p>abstract: Presented in this report is an overview of Medicaid enrollment, utilization, and expenditures in California during 1981. The California Medicaid program, called Medi-Cal, is the largest in the Nation in terms of program beneficiaries. During 1981, California had one of the most generous Medicaid programs in the country in terms of eligibility and covered services. At the same time, there were benefit limitations and reimbursement restrictions in place that were designed to restrict program expenditures. The data in this report were provided by the State to the Health Care Financing Administration as part of the Medicaid Tape-to-Tape Project. Data from Michigan and New York are also included for comparison purposes.</p><p>authors: Baugh, David K; Buczko, William; Ruther, Martin M; Rymer, Marilyn P</p><p>issue_mesh: Health Expenditures : Adult : Aged : Aid to Families with Dependent Children/utilization : California : Child : Data Collection : Evaluation Studies : Georgia : Human : Medicaid/utilization : Michigan : New York : Pilot Projects : Statistics : Tennessee : United States : United States Health Care Financing Administration</p><p>issue_number: 4</p><p>ntis_number: PB89-100663</p><p>page_range: 1-30</p><p>primary_author: Howell, Embry M</p><p>title: Medicaid Tape-to-Tape findings: California, New York, and Michigan, 1981.</p><p>volume: 9</p><p>year_period: 1988 Summer</p>]]></description></item><item><title>Medicare reimbursement and regression to the mean.</title><pubDate>Mon, 04 Nov 2019 02:27:55 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192034</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192034</guid><description><![CDATA[<p>abstract: There is evidence that Medicare's payment formula for health maintenance organizations (HMO's) overpays or underpays HMO's in cases of biased selection. There is also evidence that costs of biased groups regress toward the population mean cost, so the incorrect payment is temporary. We found that reimbursement regressed toward the mean for cohorts biased on medical use but not for groups biased on demographic factors. In a simulation of HMO-favorable selection, Medicare lost money in the first 3 years, but, because of regression toward the mean, early losses were recouped by the seventh year.</p><p>authors: N/A</p><p>issue_mesh: Capitation Fee : Fees and Charges : Insurance, Health, Reimbursement : Aged : Data Collection : Health Maintenance Organizations/economics : Human : Medicare/utilization : Models, Theoretical : Regression Analysis : Risk : United States</p><p>issue_number: 3</p><p>ntis_number: PB88-218862</p><p>page_range: 9-22</p><p>primary_author: Beebe, James C</p><p>title: Medicare reimbursement and regression to the mean.</p><p>volume: 9</p><p>year_period: 1988 Spring</p>]]></description></item><item><title>The first 3 years of Medicare prospective payment: an overview.</title><pubDate>Mon, 04 Nov 2019 02:27:55 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192039</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192039</guid><description><![CDATA[<p>abstract: This article provides a synopsis of the available evidence on the impact of the Medicare prospective payment system (PPS) for hospitals over the first 3 years of its implementation. The impact of PPS on hospitals, Medicare beneficiaries, post-hospital care, other payers for inpatient hospital services, other health care providers, and Medicare program operations and expenditures is examined.</p><p>authors: Eggers, Paul W; Greene, Timothy F; Riley, Gerald F; Terrell, Sherry A</p><p>issue_mesh: Prospective Payment System : Data Collection : Economics, Hospital/trends : Evaluation Studies : Medicare/organization &#x26; administration : United States</p><p>issue_number: 3</p><p>ntis_number: PB88-218862</p><p>page_range: 67-77</p><p>primary_author: Guterman, Stuart</p><p>title: The first 3 years of Medicare prospective payment: an overview.</p><p>volume: 9</p><p>year_period: 1988 Spring</p>]]></description></item><item><title>State tax incentives for person giving informal care of the elderly.</title><pubDate>Mon, 04 Nov 2019 02:27:55 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192067</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192067</guid><description><![CDATA[<p>ntis_number: PB89-188494</p><p>page_range: 123-128</p><p>primary_author: Hendrickson, Michael C</p><p>title: State tax incentives for person giving informal care of the elderly.</p><p>volume: Supp.</p><p>year_period: 1988 Supp.</p>]]></description></item><item><title>A perspective on long-term care for the elderly.</title><pubDate>Mon, 04 Nov 2019 02:27:55 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192052</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192052</guid><description><![CDATA[<p>ntis_number: PB89-188494</p><p>page_range: 7-16</p><p>primary_author: Scanlon, William J</p><p>title: A perspective on long-term care for the elderly.</p><p>volume: Supp.</p><p>year_period: 1988 Supp.</p>]]></description></item><item><title>Using diagnosis-related groups for studying variations in hospital admissions.</title><pubDate>Mon, 04 Nov 2019 02:27:55 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192045</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192045</guid><description><![CDATA[<p>abstract: The diagnosis-related groups (DRG's) have classically focused on resources consumed during a hospital stay. DRG's can also be considered categories for describing cases admitted to a hospital. In this article, we illustrate how consistent patterns of variations in admission rates can be used to classify DRG categories according to the Index of Discretionary Admissions. The consistency of variation in admission rates for modified DRG categories across hospital service areas in Iowa, California, Massachusetts, and Maine was high. The proportion of hospital admissions in the DRG's judged to be most discretionary ranged from 22 percent in Iowa to 14 percent in California.</p><p>authors: McPherson, Klim; Wennberg, John E</p><p>issue_mesh: Catchment Area (Health) : Diagnosis-Related Groups : California : Data Collection : Hospitals/utilization : Iowa : Maine : Massachusetts : Patient Admission/trends : Statistics : Support, Non-U.S. Gov't : Support, U.S. Gov't, Non-P.H.S. : Support, U.S. Gov't, P.H.S.</p><p>issue_number: 4</p><p>ntis_number: PB89-100663</p><p>page_range: 53-62</p><p>primary_author: Roos, Noralou P</p><p>title: Using diagnosis-related groups for studying variations in hospital admissions.</p><p>volume: 9</p><p>year_period: 1988 Summer</p>]]></description></item><item><title>Medicare hospice benefit: early program experiences.</title><pubDate>Mon, 04 Nov 2019 02:27:55 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192048</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192048</guid><description><![CDATA[<p>abstract: In this article, an overview of the Medicare hospice benefit is presented and selected preliminary findings from the Medicare hospice benefit program evaluation are provided. By mid-1987, about one-half of all community home health agency-based hospices were Medicare certified, compared with about one-fifth of all independent/freestanding hospices and one-seventh of hospital and skilled nursing facility-based hospices. Medicare beneficiary election of the hospice benefit increased from about 2,000 beneficiaries in fiscal year 1984 to about 11,000 during fiscal year 1986. Medicare reimbursed hospices an average of $1,798, $2,078 and $2,337 per patient during fiscal years 1984, 1985, and 1986, respectively.</p><p>authors: N/A</p><p>issue_mesh: Certification : Evaluation Studies : Health Expenditures/trends : Hospices/economics : Length of Stay/economics : Medicare/utilization : Research Design : Statistics : Tax Equity and Fiscal Responsibility Act : United States</p><p>issue_number: 4</p><p>ntis_number: PB89-100663</p><p>page_range: 99-111</p><p>primary_author: Davis, Feather A</p><p>title: Medicare hospice benefit: early program experiences.</p><p>volume: 9</p><p>year_period: 1988 Summer</p>]]></description></item><item><title>Long-term care in international perspective.</title><pubDate>Mon, 04 Nov 2019 02:27:55 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192071</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192071</guid><description><![CDATA[<p>ntis_number: PB89-188494</p><p>page_range: 145-155</p><p>primary_author: Doty, Pamela</p><p>title: Long-term care in international perspective.</p><p>volume: Supp.</p><p>year_period: 1988 Supp.</p>]]></description></item><item><title>Total charges for inpatient medical rehabilitation.</title><pubDate>Mon, 04 Nov 2019 02:27:55 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192043</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192043</guid><description><![CDATA[<p>abstract: Descriptive information on inpatient charges for a sample of 151 individuals discharged from three Boston area medical rehabilitation facilities is presented in this article. The total charges for inpatient rehabilitation were nearly $3 million, and the mean charge was $19,568. Also presented are a description of how charges vary by medical, demographic, social, and external factors and an identification of predictors of total charges for inpatient medical rehabilitation. These results establish a reference point for developing prospective payment systems for inpatient medical rehabilitation.</p><p>authors: Branch, Laurence G; Campion, Edward W; DeJong, Gerben; Osberg, J Scott; Seward, Marymae L</p><p>issue_mesh: Fees and Charges : Health Expenditures : Analysis of Variance : Boston : Chronic Disease/economics : Data Collection : Diagnosis-Related Groups/economics : Hospitalization/economics : Hospitals : Human : Longitudinal Studies : Medicare/utilization : Regression Analysis : Rehabilitation Centers/utilization : Support, U.S. Gov't, Non-P.H.S.</p><p>issue_number: 4</p><p>ntis_number: PB89-100663</p><p>page_range: 31-40</p><p>primary_author: McGinnis, Gayle E</p><p>title: Total charges for inpatient medical rehabilitation.</p><p>volume: 9</p><p>year_period: 1988 Summer</p>]]></description></item><item><title>Case management for long-term and acute medical care.</title><pubDate>Mon, 04 Nov 2019 02:27:55 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192056</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192056</guid><description><![CDATA[<p>ntis_number: PB89-188494</p><p>page_range: 53-55</p><p>primary_author: Capitman, John A</p><p>title: Case management for long-term and acute medical care.</p><p>volume: Supp.</p><p>year_period: 1988 Supp.</p>]]></description></item><item><title>High-cost users of medical care.</title><pubDate>Mon, 04 Nov 2019 02:27:55 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192044</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192044</guid><description><![CDATA[<p>abstract: Based on data from the National Medical Care Utilization and Expenditure Survey, the 10 percent of the noninstitutionalized U.S. population that incurred the highest medical care charges was responsible for 75 percent of all incurred charges. Health status was the strongest predictor of high-cost use, followed by economic factors. Persons 65 years of age or over incurred far higher costs than younger persons and had higher out-of-pocket costs, absolutely and as a percentage of income, although they were more likely to be insured.</p><p>authors: Iannacchione, Vincent G; Riley, Gerald F</p><p>issue_mesh: Health Expenditures : Health Status Indicators : Health Surveys : Adult : Age Factors : Aged : Data Collection : Demography : Human : Middle Age : Models, Theoretical : Personal Health Services/utilization : Regression Analysis : Sex Factors : Socioeconomic Factors : United States</p><p>issue_number: 4</p><p>ntis_number: PB89-100663</p><p>page_range: 41-52</p><p>primary_author: Garfinkel, Steven A</p><p>title: High-cost users of medical care.</p><p>volume: 9</p><p>year_period: 1988 Summer</p>]]></description></item><item><title>Financing services for developmentally disabled people: directions for reform.</title><pubDate>Mon, 04 Nov 2019 02:27:55 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192063</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192063</guid><description><![CDATA[<p>ntis_number: PB89-188494</p><p>page_range: 103-107</p><p>primary_author: Tompkins, Arnold R</p><p>title: Financing services for developmentally disabled people: directions for reform.</p><p>volume: Supp.</p><p>year_period: 1988 Supp.</p>]]></description></item><item><title>Medicare discharges by facility status under the prospective payment system, 1984-86.</title><pubDate>Mon, 04 Nov 2019 02:27:55 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192024</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192024</guid><description><![CDATA[<p>abstract: When the Health Care Financing Administration implemented the Medicare prospective payment system (PPS), several types of hospitals and hospital units were excluded from the new reimbursement system, and they remained under the reasonable cost reimbursement system, subject to the target rate of increase limits. The implementation of PPS has been accompanied by several changes in hospital classification and in utilization patterns. This article examines some of these changes based on excluded facility counts and discharges by facility status under the PPS for fiscal years 1984-86.</p><p>authors: Gibson, David A</p><p>issue_mesh: Data Collection : Hospitals/classification : Medicare/organization &#x26; administration : Patient Discharge/trends : Prospective Payment System/organization &#x26; administration : United States</p><p>issue_number: 1</p><p>ntis_number: PB88-160221</p><p>page_range: 97-101</p><p>primary_author: Hatten, James M</p><p>title: Medicare discharges by facility status under the prospective payment system, 1984-86.</p><p>volume: 9</p><p>year_period: 1987 Fall</p>]]></description></item><item><title>Impact of State hospital rate setting on capital formation.</title><pubDate>Mon, 04 Nov 2019 02:27:55 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191998</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191998</guid><description><![CDATA[<p>abstract: For this article, a new national data base of Medicare's cost reports on more than 2,000 hospitals is used to measure the impact of State prospective rate setting on capital formation. Several investment measures are analyzed, both in nominal and real terms, using a combination of descriptive and multivariate techniques. Results indicate that, over the last decade, State hospital rate-setting programs have had little demonstrable effect on capital formation and they have not caused any significant aging of plant assets. Programs in both New York and Massachusetts were found to be associated with a slowing in the rate of bed growth, however, resulting in significant long-term cost savings.</p><p>authors: N/A</p><p>issue_mesh: Capital Financing : Financial Management : Prospective Payment System : Data Collection : Hospitals, Community/economics : Investments/economics : Medicare/economics : Rate Setting and Review/legislation &#x26; jurisprudence : State Government : Support, U.S. Gov't, Non-P.H.S. : United States</p><p>issue_number: 3</p><p>ntis_number: PB88-131578</p><p>page_range: 69-82</p><p>primary_author: Cromwell, Jerry L</p><p>title: Impact of State hospital rate setting on capital formation.</p><p>volume: 8</p><p>year_period: 1987 Spring</p>]]></description></item><item><title>EPSDT impact on health status.</title><pubDate>Mon, 04 Nov 2019 02:27:55 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191602</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191602</guid><description><![CDATA[<p>abstract: Early and Periodic Screening, Diagnosis and Treatment (EPSDT), a large-scale operational screening program which has generated a tremendous volume of data on the sociodemographic characteristics and health status of Medicaid-eligible children, seems to provide an ideal context within which to evaluate the effectiveness of preventive child health care. Concerns about health care expenditures generally, and the effectiveness of preventive child health services specifically, lead to the question of whether the impact on the health status of the children served can be measured without significantly adding to the cost of these services with primary data collection. We employed a quasi-experimental research design using administratively-generated data from an operational EPSDT program to estimate program impact on the prevalence of serious abnormalities among the children served. We found that, compared either to themselves across time or to a control group, a representative sample of 1831 children had almost 30 percent fewer abnormalities requiring care on rescreening. The ability to demonstrate the impact of EPSDT using these data suggests, among other things relevant to policy, that a national EPSDT monitoring system could be developed that would be cost-effective and could lead to program improvement.</p><p>authors: Conroy-Hughes, Rosemary</p><p>issue_mesh: Health : Health Status : Child : Child Health Services/utilization : Evaluation Studies : Human : Multiphasic Screening/utilization : Pennsylvania : Statistics : Support, U.S. Gov't, P.H.S.</p><p>issue_number: 4</p><p>ntis_number: PB82-130154</p><p>page_range: 25-39</p><p>primary_author: Irwin, Patrick H</p><p>title: EPSDT impact on health status.</p><p>volume: 2</p><p>year_period: 1981 Spring</p>]]></description></item><item><title>Reimbursement under diagnosis-related groups: the Medicaid experience.</title><pubDate>Mon, 04 Nov 2019 02:27:54 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191988</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191988</guid><description><![CDATA[<p>abstract: The implementation of the Medicare prospective payment system has sparked the growth of similar Medicaid systems. Eight State Medicaid agencies now employ a system based on diagnosis-related groups (DRG's), and another four State Medicaid agencies are planning to implement such systems in the near future. The eight DRG-based systems in existence in 1986 are examined in this article. Preliminary evidence presented herein indicates that Medicaid DRG-based systems have experienced reduced rates of increase in expenditures for hospital services and that hospital admission rates have not increased under these systems.</p><p>authors: N/A</p><p>issue_mesh: Prospective Payment System : Diagnosis-Related Groups/economics : Hospitalization/economics : Medicaid/organization &#x26; administration : State Government : United States</p><p>issue_number: 2</p><p>ntis_number: PB88-131586</p><p>page_range: 35-44</p><p>primary_author: Hellinger, Fred J</p><p>title: Reimbursement under diagnosis-related groups: the Medicaid experience.</p><p>volume: 8</p><p>year_period: 1986 Winter</p>]]></description></item><item><title>Medicaid recipients in intermediate care facilities for the mentally retarded.</title><pubDate>Mon, 04 Nov 2019 02:27:54 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191993</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191993</guid><description><![CDATA[<p>abstract: In this study, we examined Medicaid utilization and expenditure patterns of Medicaid recipients in intermediate care facilities for the mentally retarded (ICF's/MR) in three States: California, Georgia, and Michigan. Data were obtained from uniform Medicaid data files (Tape-to-Tape project). Most recipients in ICF's/MR were nonelderly adults with severe or profound mental retardation who were in an ICF/MR for the entire year. The average annual cost of care ranged from $26,617 per recipient in Georgia to $36,128 per recipient in Michigan. The vast majority of recipients were low utilizers of other Medicaid services. Approximately one-third of the recipients were also covered by Medicare.</p><p>authors: Clauser, Steven B; Hall, Margaret J; Simon, James</p><p>issue_mesh: Adult : Age Factors : California : Data Collection : Georgia : Health Expenditures : Human : Intermediate Care Facilities/economics : Medicaid/utilization : Mental Retardation/economics : Michigan : Middle Age : Nursing Homes/economics : Support, U.S. Gov't, Non-P.H.S.</p><p>issue_number: 3</p><p>ntis_number: PB88-131578</p><p>page_range: 1-12</p><p>primary_author: Burwell, Brian O</p><p>title: Medicaid recipients in intermediate care facilities for the mentally retarded.</p><p>volume: 8</p><p>year_period: 1987 Spring</p>]]></description></item><item><title>Private sector initiatives in case management.</title><pubDate>Mon, 04 Nov 2019 02:27:54 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192061</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192061</guid><description><![CDATA[<p>ntis_number: PB89-188494</p><p>page_range: 89-95</p><p>primary_author: Henderson, Mary G</p><p>title: Private sector initiatives in case management.</p><p>volume: Supp.</p><p>year_period: 1988 Supp.</p>]]></description></item><item><title>Reviewing the quality of care: priorities for improvement.</title><pubDate>Mon, 04 Nov 2019 02:27:54 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192015</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192015</guid><description><![CDATA[<p>ntis_number: PB89-136956</p><p>page_range: 69-74</p><p>primary_author: Roberts, James S</p><p>title: Reviewing the quality of care: priorities for improvement.</p><p>volume: Supp.</p><p>year_period: 1987 Supp.</p>]]></description></item><item><title>Reforming long-term care financing through insurance.</title><pubDate>Mon, 04 Nov 2019 02:27:54 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192064</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192064</guid><description><![CDATA[<p>ntis_number: PB89-188494</p><p>page_range: 109-112</p><p>primary_author: Meiners, Mark R</p><p>title: Reforming long-term care financing through insurance.</p><p>volume: Supp.</p><p>year_period: 1988 Supp.</p>]]></description></item><item><title>Monitoring adverse outcomes of surgery using administrative data.</title><pubDate>Mon, 04 Nov 2019 02:27:54 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192009</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192009</guid><description><![CDATA[<p>ntis_number: PB89-136956</p><p>page_range: 5-16</p><p>primary_author: Roos, Leslie L</p><p>title: Monitoring adverse outcomes of surgery using administrative data.</p><p>volume: Supp.</p><p>year_period: 1987 Supp.</p>]]></description></item><item><title>Recent trends in financing long-term care.</title><pubDate>Mon, 04 Nov 2019 02:27:54 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192062</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192062</guid><description><![CDATA[<p>ntis_number: PB89-188494</p><p>page_range: 97-102</p><p>primary_author: Wallack, Stanley S</p><p>title: Recent trends in financing long-term care.</p><p>volume: Supp.</p><p>year_period: 1988 Supp.</p>]]></description></item><item><title>Medicare outpatient clinical laboratory services payments: relative value scale approach.</title><pubDate>Mon, 04 Nov 2019 02:27:54 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191989</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191989</guid><description><![CDATA[<p>abstract: The Health Care Financing Administration is in the process of designing a competitive bidding model for the purchase of outpatient clinical laboratory services. One segment of this process involves the development of a relative value scale (RVS). The RVS could be used as part of the bidding process and as the basis of payment. The RVS could also be used as the basis of a national fee schedule, as stipulated in the Deficit Reduction Act of 1984. Potential problems with the development of an RVS from local (carrier) fee schedules for outpatient clinical laboratory services were investigated.</p><p>authors: Clopton, Thomas A</p><p>issue_mesh: Competitive Bidding : Fee Schedules : Financial Management : Reimbursement Mechanisms : Data Collection : Laboratory Techniques and Procedures/economics : Medicare/organization &#x26; administration : Statistics : United States : United States Health Care Financing Administration</p><p>issue_number: 2</p><p>ntis_number: PB88-131586</p><p>page_range: 45-52</p><p>primary_author: Gurny, Paul</p><p>title: Medicare outpatient clinical laboratory services payments: relative value scale approach.</p><p>volume: 8</p><p>year_period: 1986 Winter</p>]]></description></item><item><title>Relative value scales for physicians' services.</title><pubDate>Mon, 04 Nov 2019 02:27:54 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191910</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191910</guid><description><![CDATA[<p>abstract: A key element in the construction of a physician fee schedule is the underlying relative value scale (RVS). The focus in this article is on the development and comparison of RVS's based on alternative data sources and construction methods. Results suggest that medical procedures' values are preserved across alternative charge-based RVS's. Some differences are observed, however, when comparing procedures' values on scales derived from charges versus those derived from time data. The major conclusion is that the choice of a charge data base and method of constructing an RVS need not be a primary concern in the process of developing physicians' fee schedules.</p><p>authors: Hadley, James P</p><p>issue_mesh: Fee Schedules : Fees, Medical : Methods : Models, Theoretical : Rate Setting and Review/methods : United States</p><p>issue_number: 4</p><p>ntis_number: PB86-139409</p><p>page_range: 93-101</p><p>primary_author: Juba, David A</p><p>title: Relative value scales for physicians' services.</p><p>volume: 6</p><p>year_period: 1985 Summer</p>]]></description></item><item><title>Impact of the prospective payment system on physician charges under Medicare.</title><pubDate>Mon, 04 Nov 2019 02:27:54 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192007</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192007</guid><description><![CDATA[<p>authors: N/A</p><p>issue_mesh: Prospective Payment System : Fees, Medical/trends : Insurance, Physician Services/economics : Medicare/economics : Statistics : United States</p><p>issue_number: 4</p><p>ntis_number: PB88-131339</p><p>page_range: 101-103</p><p>primary_author: Fisher, Charles R</p><p>title: Impact of the prospective payment system on physician charges under Medicare.</p><p>volume: 8</p><p>year_period: 1987 Summer</p>]]></description></item><item><title>The measurement of nursing intensity.</title><pubDate>Mon, 04 Nov 2019 02:27:54 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191880</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191880</guid><description><![CDATA[<p>ntis_number: PB85-155083</p><p>page_range: 47-55</p><p>primary_author: Thompson, John D</p><p>title: The measurement of nursing intensity.</p><p>volume: Supp.</p><p>year_period: 1984 Supp.</p>]]></description></item><item><title>Case management of persons with acquired immunodeficiency syndrome in San Francisco.</title><pubDate>Mon, 04 Nov 2019 02:27:54 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192058</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192058</guid><description><![CDATA[<p>ntis_number: PB89-188494</p><p>page_range: 69-74</p><p>primary_author: Benjamin, A E</p><p>title: Case management of persons with acquired immunodeficiency syndrome in San Francisco.</p><p>volume: Supp.</p><p>year_period: 1988 Supp.</p>]]></description></item><item><title>Symposium: case-mix measurement and assessing quality of hospital care.</title><pubDate>Mon, 04 Nov 2019 02:27:54 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192012</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192012</guid><description><![CDATA[<p>ntis_number: PB89-136956</p><p>page_range: 39-48</p><p>primary_author: Brook, Robert H</p><p>title: Symposium: case-mix measurement and assessing quality of hospital care.</p><p>volume: Supp.</p><p>year_period: 1987 Supp.</p>]]></description></item><item><title>Use and cost of hospital outpatient services under Medicare, 1985.</title><pubDate>Mon, 04 Nov 2019 02:27:54 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192049</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192049</guid><description><![CDATA[<p>abstract: Presented in this article are program data on the use and cost of hospital outpatient (HOP) services rendered to aged and disabled Medicare beneficiaries during calendar year 1985. Trend data are also presented for calendar years 1974-85. The data shown in this article focus on charges, reimbursements, and reimbursements per enrollee as a means of measuring the cost of HOP services. The data provide information to help identify trends and patterns of care for monitoring the Medicare HOP benefit and for evaluating the impact of the inpatient hospital prospective payment system (PPS) on the use and cost of HOP services.</p><p>authors: Latta, Viola B</p><p>issue_mesh: Outpatients : Patients : Ambulatory Care/economics/utilization : Catchment Area (Health) : Costs and Cost Analysis : Health Expenditures/trends : Medicare/utilization : Outpatient Clinics, Hospital/economics/utilization : Prospective Payment System : Statistics : United States</p><p>issue_number: 4</p><p>ntis_number: PB89-100663</p><p>page_range: 113-125</p><p>primary_author: Helbing, Charles</p><p>title: Use and cost of hospital outpatient services under Medicare, 1985.</p><p>volume: 9</p><p>year_period: 1988 Summer</p>]]></description></item><item><title>Theory and practice for measuring health care quality.</title><pubDate>Mon, 04 Nov 2019 02:27:54 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192013</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192013</guid><description><![CDATA[<p>ntis_number: PB89-136956</p><p>page_range: 49-55</p><p>primary_author: Berwick, Donald M</p><p>title: Theory and practice for measuring health care quality.</p><p>volume: Supp.</p><p>year_period: 1987 Supp.</p>]]></description></item><item><title>Setting capitation payments in markets for health services.</title><pubDate>Mon, 04 Nov 2019 02:27:54 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192003</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192003</guid><description><![CDATA[<p>abstract: Health maintenance organizations (HMO's) are paid a capitated amount for enrolled Medicare beneficiaries that is 95 percent of what these enrollees would be expected to cost in the fee-for-service sector. However, it appears that HMO enrollees are less costly than other Medicare beneficiaries. With a simulation model, we demonstrate that with a 95-percent pricing rule, any significant degree of biased selection leads to increased cost to the payer, even when HMO's are cost effective compared with the fee-for-service sector. Optimal pricing percentages from the point of view of cost minimization are considerably less than 95 percent.</p><p>authors: McGuire, Thomas G</p><p>issue_mesh: Capitation Fee : Fees and Charges : Costs and Cost Analysis : Health Maintenance Organizations/economics : Medicare/economics : Models, Theoretical : Rate Setting and Review/methods : Risk : Statistics : Support, Non-U.S. Gov't : Support, U.S. Gov't, Non-P.H.S. : United States : United States Health Care Financing Administration</p><p>issue_number: 4</p><p>ntis_number: PB88-131339</p><p>page_range: 55-64</p><p>primary_author: Ellis, Randall P</p><p>title: Setting capitation payments in markets for health services.</p><p>volume: 8</p><p>year_period: 1987 Summer</p>]]></description></item><item><title>State preadmission screening programs for controlling utilization of long-term care.</title><pubDate>Mon, 04 Nov 2019 02:27:54 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192019</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192019</guid><description><![CDATA[<p>abstract: This article explores the issue o whether state-administered nursing home preadmission screening (PAS) programs are an effective means of controlling the utilization of long-term care. It is suggested that, overall, PAS may be increasing rather than decreasing the use of long-term care. Utilization control through PAS may be ineffective because it occurs too late in the placement decision process, there are insufficient placement alternatives, assessment tools do not adequately identify who is at risk of institutionalization, and policymakers and program administrators may have conflicting goals. Recommendations for improving the screening process include, among others, that States more clearly define program goals and that screening be conducted within a managed-care system.</p><p>authors: Iversen, Laura H</p><p>issue_mesh: Government : State Government : Utilization Review : Cost Control : Long-Term Care/utilization : Medicaid/utilization : Patient Care Planning/methods : Support, Non-U.S. Gov't : United States</p><p>issue_number: 1</p><p>ntis_number: PB88-160221</p><p>page_range: 43-49</p><p>primary_author: Polich, Cynthia L</p><p>title: State preadmission screening programs for controlling utilization of long-term care.</p><p>volume: 9</p><p>year_period: 1987 Fall</p>]]></description></item><item><title>Quality of health care measurement: a research priority.</title><pubDate>Mon, 04 Nov 2019 02:27:54 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192008</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192008</guid><description><![CDATA[<p>ntis_number: PB89-136956</p><p>page_range: 1-4</p><p>primary_author: Davis, Feather A</p><p>title: Quality of health care measurement: a research priority.</p><p>volume: Supp.</p><p>year_period: 1987 Supp.</p>]]></description></item><item><title>A multidimensional approach to case mix for home health services.</title><pubDate>Mon, 04 Nov 2019 02:27:54 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192002</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192002</guid><description><![CDATA[<p>abstract: Developing a case-mix methodology for home health services is more difficult than developing one for hospitalization and acute health services, because the determinants of need for home health care are more complex and because of the difficulty in defining episodes of care. To evaluate home health service case mix, a multivariate grouping methodology was applied to records from the 1982 National Long-Term Care Survey linked to Medicare records on home health reimbursements. Using this method, six distinct health and functional status dimensions were identified. These dimensions, combined with factors describing informal care resources and local market conditions, were used to explain significant proportions of the variance (r2 = .45) of individual differences in Medicare home health reimbursements and numbers of visits. Though the data were not collected for that purpose, the high level of prediction strongly suggests the feasibility of developing case-mix strategies for home health services.</p><p>authors: Hausner, Tony</p><p>issue_mesh: Diagnosis-Related Groups/methods : Home Care Services/economics : Long-Term Care/classification : Medicare/economics : Models, Theoretical : Reimbursement Mechanisms : Statistics : United States</p><p>issue_number: 4</p><p>ntis_number: PB88-131339</p><p>page_range: 37-54</p><p>primary_author: Manton, Kenneth G</p><p>title: A multidimensional approach to case mix for home health services.</p><p>volume: 8</p><p>year_period: 1987 Summer</p>]]></description></item><item><title>Self-insured health plans.</title><pubDate>Mon, 04 Nov 2019 02:27:54 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191985</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191985</guid><description><![CDATA[<p>abstract: Nationwide, 8 percent of all employment-related health plans were self-insured in 1984, which translates into more than 175,000 self-insured plans according to our latest study of independent health plans. The propensity of an organization to self-insure differs primarily by its size, with large establishments more likely to self-insure. In the overwhelming majority of cases, the self-insured benefit was hospital and/or medical. Among employers who self-insure, 23 percent self-administer, and the remaining 77 percent hire a commercial insurance company, Blue Cross/Blue Shield plan, or an independent third-party administrator to administer the health plan.</p><p>authors: Arnett 3d, Ross H; Greenberg, Leonard; Guttenberg, Abbie</p><p>issue_mesh: Organizations : Data Collection : Government : Health Benefit Plans, Employee/organization &#x26; administration : Health Maintenance Organizations : Industry : Insurance, Health/organization &#x26; administration : Labor Unions : Religion : Schools : Statistics : United States : United States Health Care Financing Administration</p><p>issue_number: 2</p><p>ntis_number: PB88-131586</p><p>page_range: 1-16</p><p>primary_author: McDonnell, Patricia A</p><p>title: Self-insured health plans.</p><p>volume: 8</p><p>year_period: 1986 Winter</p>]]></description></item><item><title>Using prior utilization to determine payments for Medicare enrollees in health maintenance organizations.</title><pubDate>Mon, 04 Nov 2019 02:27:52 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191900</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191900</guid><description><![CDATA[<p>abstract: The Tax Equity and Fiscal Responsibility Act of 1982 is expected to make it more attractive for health maintenance organizations (HMO's) to participate in the Medicare program on an at-risk basis. Currently, payments to at-risk HMO's are based on a formula known as the adjusted average per capita cost (AAPCC). This article describes the current formula and discusses a modification, based on prior use of Medicare services, that endeavors to more accurately predict risk. Using statistical simulations, formulas incorporating prior use performed better for some types of biased groups than a formula similar to the one currently employed. Major concerns involve the ability to "game the system." The prior-use model is now being tested in an HMO demonstration. This article also outlines the limitations of a prior-use model and areas for future research.</p><p>authors: Eggers, Paul W; Lubitz, James</p><p>issue_mesh: Forecasting/methods : Health Maintenance Organizations/economics : Medicare/utilization : Models, Theoretical : Rate Setting and Review/methods : Regression Analysis : Reimbursement Mechanisms : Tax Equity and Fiscal Responsibility Act : United States</p><p>issue_number: 3</p><p>ntis_number: PB85-226165</p><p>page_range: 27-38</p><p>primary_author: Beebe, James C</p><p>title: Using prior utilization to determine payments for Medicare enrollees in health maintenance organizations.</p><p>volume: 6</p><p>year_period: 1985 Spring</p>]]></description></item><item><title>Capitation pricing: adjusting for prior utilization and physician discretion.</title><pubDate>Mon, 04 Nov 2019 02:27:52 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191987</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191987</guid><description><![CDATA[<p>abstract: As the number of Medicare beneficiaries receiving care under at-risk capitation arrangements increases, the method for setting payment rates will come under increasing scrutiny. A number of modifications to the current adjusted average per capita cost (AAPCC) methodology have been proposed, including an adjustment for prior utilization. In this article, we propose use of a utilization adjustment that includes only hospitalizations involving low or moderate physician discretion in the decision to hospitalize. This modification avoids discrimination against capitated systems that prevent certain discretionary admissions. The model also explains more of the variance in per capita expenditures than does the current AAPCC.</p><p>authors: Cantor, Joel C; Holloway, James J; Steinberg, Earl P</p><p>issue_mesh: Capitation Fee : Fees and Charges : Health Expenditures : Physician's Role : Role : Costs and Cost Analysis/methods : Hospitalization/economics : Medicare/utilization : Models, Theoretical : Rate Setting and Review/methods : Statistics : United States : United States Health Care Financing Administration</p><p>issue_number: 2</p><p>ntis_number: PB88-131586</p><p>page_range: 27-34</p><p>primary_author: Anderson, Gerald F</p><p>title: Capitation pricing: adjusting for prior utilization and physician discretion.</p><p>volume: 8</p><p>year_period: 1986 Winter</p>]]></description></item><item><title>Socioeconomic factors and Medicare supplemental health insurance.</title><pubDate>Mon, 04 Nov 2019 02:27:52 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192017</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192017</guid><description><![CDATA[<p>abstract: This analysis was conducted to determine how personal and community characteristics affect coverage by private insurance to supplement Medicare. Data from the 1980 National Medical Care Utilization and Expenditure Survey were used. After controlling for health status, it was found that supplemental coverage was positively associated with education, income, number of self-reported chronic conditions, being white, being married, and having a regular source of care. Private coverage was negatively associated with Medicaid coverage and age. The only community characteristic associated with supplemental coverage was region. Consideration of local medical resources and economic measures did not change that.</p><p>authors: Bonito, Arthur J; McLeroy, Kenneth R</p><p>issue_mesh: Data Collection : Deductibles and Coinsurance : Human : Insurance, Health/supply &#x26; distribution : Medicare/utilization : Regression Analysis : Socioeconomic Factors : Support, U.S. Gov't, Non-P.H.S. : United States</p><p>issue_number: 1</p><p>ntis_number: PB88-160221</p><p>page_range: 21-30</p><p>primary_author: Garfinkel, Steven A</p><p>title: Socioeconomic factors and Medicare supplemental health insurance.</p><p>volume: 9</p><p>year_period: 1987 Fall</p>]]></description></item><item><title>Functional health measure for adjusting health maintenance organization capitation rates.</title><pubDate>Mon, 04 Nov 2019 02:27:52 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191950</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191950</guid><description><![CDATA[<p>abstract: Because of increasing interest in at-risk enrollment of Medicare beneficiaries by health maintenance organizations, a number of modifications to the adjusted average per capita cost (AAPCC) formula employed by the Health Care Financing Administration have been proposed recently. Researchers have found that new models, which include measures of prior years' utilization and costs, predict Medicare payments significantly better than does the purely demographic formula currently used. In this article, we show that inclusion of instrumental activities of daily living (IADL), a measure of beneficiaries' functional health status, can further improve AAPCC models that already incorporate measures of previous-period utilization and costs. Various models for predicting Medicare payments were examined and compared using survey data and Medicare claims for a random sample of 1,934 beneficiaries. For these models, explained variation in subsequent Medicare payments (as indicated by R2 values) increased considerably when the IADL variable was included. Although actuarial concerns are associated with inclusion of the IADL score in the AAPCC, use of this measure is likely to offset other, possibly more serious, actuarial problems associated with including measures of previous utilization and costs.</p><p>authors: Lichtenstein, Richard</p><p>issue_mesh: Activities of Daily Living : Capitation Fee : Fees and Charges : Medicare : Actuarial Analysis : Aged : Female : Health Maintenance Organizations/economics : Health Status : Human : Male : Michigan : Rate Setting and Review/methods : Regression Analysis : Support, U.S. Gov't, Non-P.H.S.</p><p>issue_number: 3</p><p>ntis_number: PB86-217973</p><p>page_range: 85-95</p><p>primary_author: Thomas, J William</p><p>title: Functional health measure for adjusting health maintenance organization capitation rates.</p><p>volume: 7</p><p>year_period: 1986 Spring</p>]]></description></item><item><title>Factors affecting laboratory test use and prices.</title><pubDate>Mon, 04 Nov 2019 02:27:52 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191870</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191870</guid><description><![CDATA[<p>abstract: The use of clinical laboratory tests has more than doubled during the past decade. Some observers of the health system feel that this growth is excessive and is a result of current payment systems. This article examines the effects of current reimbursement policies with regard to the use of laboratory tests and prices charged for tests. The results suggest the following: The method of financing medical care, including cost sharing and prepaid group practice arrangements, affects the volume of laboratory testing through the number of patient contacts with the medical care system rather than through the number of tests used per patient contact. Fee ceilings on physician time appear to be partially offset by higher test prices. Cost-based reimbursement for hospital services is associated with higher charges in hospital laboratories.</p><p>authors: Manning Jr, Willard G; Marquis, M Susan</p><p>issue_mesh: Reimbursement Mechanisms : Comparative Study : Fees, Medical : Health Maintenance Organizations : Hospitals : Laboratory Techniques and Procedures/economics/utilization : Medicare : United States</p><p>issue_number: 4</p><p>ntis_number: PB84-229343</p><p>page_range: 23-32</p><p>primary_author: Danzon, Patricia M</p><p>title: Factors affecting laboratory test use and prices.</p><p>volume: 5</p><p>year_period: 1984 Summer</p>]]></description></item><item><title>Long-term care financing through Federal tax incentives.</title><pubDate>Mon, 04 Nov 2019 02:27:52 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192066</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192066</guid><description><![CDATA[<p>ntis_number: PB89-188494</p><p>page_range: 117-121</p><p>primary_author: Moran, Donald W</p><p>title: Long-term care financing through Federal tax incentives.</p><p>volume: Supp.</p><p>year_period: 1988 Supp.</p>]]></description></item><item><title>Selection bias in health maintenance organizations: analysis of recent evidence.</title><pubDate>Mon, 04 Nov 2019 02:27:52 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192028</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192028</guid><description><![CDATA[<p>abstract: An analysis of recent research regarding selection bias in health maintenance organizations (HMO's) is presented in this article. Review of the available literature leads one to conclude that prepaid group practice HMO's do experience favorable selection. It has been demonstrated in numerous studies that prior use of health services by HMO enrollees is less than prior use of health services by those who remain in the fee-for-service sector, and there is considerable evidence that shows a statistically significant positive relationship between prior use and current use. This is true for both those under 65 years of age and those 65 years of age or over.</p><p>authors: N/A</p><p>issue_mesh: Attitude to Health : Decision Making : Aged : Data Collection : Evaluation Studies : Health Maintenance Organizations/utilization : Human : Medicare : Risk Factors : Sampling Studies : Washington : Wisconsin</p><p>issue_number: 2</p><p>ntis_number: PB88-196670</p><p>page_range: 55-63</p><p>primary_author: Hellinger, Fred J</p><p>title: Selection bias in health maintenance organizations: analysis of recent evidence.</p><p>volume: 9</p><p>year_period: 1987 Winter</p>]]></description></item><item><title>Use of dental services in 1980.</title><pubDate>Mon, 04 Nov 2019 02:27:52 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192018</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192018</guid><description><![CDATA[<p>abstract: In this article, we describe the use of dental services by the civilian noninstitutionalized population of the United States in 1980. Data are presented on the extent to which this population is insured for dental expenses, their use of dental services, the charges incurred, and the sources of payment for these services.</p><p>authors: Silverman, Herbert A</p><p>issue_mesh: Data Collection : Dental Health Services/utilization : Economics, Dental/trends : Human : Insurance, Dental/supply &#x26; distribution : Statistics : United States</p><p>issue_number: 1</p><p>ntis_number: PB88-160221</p><p>page_range: 31-42</p><p>primary_author: Hunt, Nileen</p><p>title: Use of dental services in 1980.</p><p>volume: 9</p><p>year_period: 1987 Fall</p>]]></description></item><item><title>National health expenditures, 1984.</title><pubDate>Mon, 04 Nov 2019 02:27:52 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191930</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191930</guid><description><![CDATA[<p>abstract: Growth in health care expenditures slowed to 9.1 percent in 1984, the smallest increase in expenditures in 19 years. Economic forces and emerging structural changes within the health sector played a role in slowing growth. Of the $1,580 per person spent for health care in 1984, 41 percent was financed by public programs; 31 percent by private health insurance; and the remainder by other private sources. Together, Medicare and Medicaid accounted for 27 percent of all health spending.</p><p>authors: Davidoff, Laurence M; Lazenby, Helen C; Waldo, Daniel R</p><p>issue_mesh: Delivery of Health Care/trends : Financing, Government/trends : Health Expenditures/trends : Social Change : Statistics : Support, U.S. Gov't, Non-P.H.S. : United States</p><p>issue_number: 1</p><p>ntis_number: PB86-156759</p><p>page_range: 1-36</p><p>primary_author: Levit, Katharine R</p><p>title: National health expenditures, 1984.</p><p>volume: 7</p><p>year_period: 1985 Fall</p>]]></description></item><item><title>Competitive bidding for home care under the channeling demonstration.</title><pubDate>Mon, 04 Nov 2019 02:27:52 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192005</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192005</guid><description><![CDATA[<p>abstract: Competitive bidding is a relatively new strategy for setting rates and choosing providers for public medical care programs. In this article, the experience in competitive bidding by home health care providers and homemaker agencies in the National Long-Term Care Channeling Demonstration is described. Particular attention is paid to contrasting approaches that select a single winning bidder with those that select multiple winning bidders for the same service. Results are discussed with respect to bid prices, characteristics of winning bidders, administrative demands, and service delivery.</p><p>authors: N/A</p><p>issue_mesh: Competitive Bidding : Financial Management : Aged : Evaluation Studies : Financing, Government/methods : Florida : Home Care Services/economics : Human : Long-Term Care/economics : Ohio : Patient Care Planning : Pilot Projects : Rate Setting and Review/methods : Support, U.S. Gov't, Non-P.H.S. : United States</p><p>issue_number: 4</p><p>ntis_number: PB88-131339</p><p>page_range: 73-86</p><p>primary_author: Christianson, Jon B</p><p>title: Competitive bidding for home care under the channeling demonstration.</p><p>volume: 8</p><p>year_period: 1987 Summer</p>]]></description></item><item><title>Paying for physician services in state Medicaid programs.</title><pubDate>Mon, 04 Nov 2019 02:27:52 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191863</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191863</guid><description><![CDATA[<p>abstract: This article presents new information on both methods and rates of payment for physician services in State Medicaid programs. A variety of indices comparing State programs with each other and with Medicare are developed and discussed. The information is important for both State policymakers considering cost-containment strategies and for those concerned with Medicaid access to physician services.</p><p>authors: N/A</p><p>issue_mesh: Fees, Medical : Reimbursement Mechanisms : Comparative Study : Data Collection : Medicaid/economics : Medicare/economics : State Government : United States</p><p>issue_number: 3</p><p>ntis_number: PB84-189844</p><p>page_range: 99-110</p><p>primary_author: Holahan, John</p><p>title: Paying for physician services in state Medicaid programs.</p><p>volume: 5</p><p>year_period: 1984 Spring</p>]]></description></item><item><title>Medicare physician fee schedules: issues and evidence from South Carolina.</title><pubDate>Mon, 04 Nov 2019 02:27:52 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191997</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191997</guid><description><![CDATA[<p>abstract: Three key research questions are identified and analyzed in this article. First is an investigation of whether Medicare already pays physicians using de facto fee schedules. Evidence from South Carolina suggests not. Second is an evaluation of the physician procedures and specialties likely to be affected by imposition of a Medicare fee schedule. Medical visits are identified as especially susceptible. Third is a report on simulated effects of a charge-based fee schedule on Medicare program payments, physicians' practice revenues, and beneficiaries' liabilities.</p><p>authors: N/A</p><p>issue_mesh: Fee Schedules : Insurance, Physician Services : Reimbursement Mechanisms : Data Collection : Medicare/economics : South Carolina : Specialties, Medical/economics : Support, Non-U.S. Gov't : Support, U.S. Gov't, Non-P.H.S. : United States</p><p>issue_number: 3</p><p>ntis_number: PB88-131578</p><p>page_range: 57-67</p><p>primary_author: Juba, David A</p><p>title: Medicare physician fee schedules: issues and evidence from South Carolina.</p><p>volume: 8</p><p>year_period: 1987 Spring</p>]]></description></item><item><title>Overview of employer capitation activities.</title><pubDate>Mon, 04 Nov 2019 02:27:52 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191964</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191964</guid><description><![CDATA[<p>ntis_number: PB88-131552</p><p>page_range: 31-34</p><p>primary_author: Moley, Kevin E</p><p>title: Overview of employer capitation activities.</p><p>volume: Supp.</p><p>year_period: 1986 Supp.</p>]]></description></item><item><title>The Medical Care Advisory Committee for state Medicaid programs: current status and trends.</title><pubDate>Mon, 04 Nov 2019 02:27:52 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191862</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191862</guid><description><![CDATA[<p>abstract: Each State Medicaid program is required by Federal Regulations to have a Medical Care Advisory Committee ( MCAC ) which includes provider, consumer, and government representatives and which participates in policy development and program administration. Data are presented about the composition of these committees, their structure, the administrative and financial support they receive, and the nature of their activities. It is argued that they can play an important role in policy formulation and implementation, but that they need to be reformed in order to exploit that potential.</p><p>authors: Herold, Terry E; Simon, Marlene B</p><p>issue_mesh: Health Planning Councils/organization &#x26; administration : Health Planning Organizations/organization &#x26; administration : Medicaid/legislation &#x26; jurisprudence : Questionnaires : State Government : United States</p><p>issue_number: 3</p><p>ntis_number: PB84-189844</p><p>page_range: 89-98</p><p>primary_author: Davidson, Stephen M</p><p>title: The Medical Care Advisory Committee for state Medicaid programs: current status and trends.</p><p>volume: 5</p><p>year_period: 1984 Spring</p>]]></description></item><item><title>Health care use by Medicare's disabled enrollees.</title><pubDate>Mon, 04 Nov 2019 02:27:52 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191954</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191954</guid><description><![CDATA[<p>abstract: Three million persons under age 65 are entitled to Medicare because of disability. This study examines their Medicare use and mortality. Disabled enrollees had higher health care use and mortality than comparison groups of Medicare's aged enrollees or of the general population under age 65. One type of disabled enrollee, adults disabled as children (over one-half of whom are mentally retarded) show lower use rates than the other types of enrollees--workers and widows. High mortality of the disabled during the 2-year waiting period for Medicare suggests the need to investigate how they pay for care during this period.</p><p>authors: Pine, Penelope L</p><p>issue_mesh: Disabled Persons : Data Collection : Health Services/utilization : Medicare/utilization : United States</p><p>issue_number: 4</p><p>ntis_number: PB86-241262</p><p>page_range: 19-31</p><p>primary_author: Lubitz, James</p><p>title: Health care use by Medicare's disabled enrollees.</p><p>volume: 7</p><p>year_period: 1986 Summer</p>]]></description></item><item><title>Outpatient prescription drug spending by the Medicare population.</title><pubDate>Mon, 04 Nov 2019 02:27:52 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192022</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192022</guid><description><![CDATA[<p>abstract: Legislation proposed in the 100th Congress and debated during the summer of 1987 would cover prescription drug spending by Medicare enrollees after the enrollee had met a deductible. However, at the time that the legislation was proposed, there were no comprehensive estimates of the extent of current expenditures for prescription drugs by that population, nor of the expected cost of the proposed coverage. In this article, the author estimates "current-law" drug spending by Medicare enrollees. A distribution around the average expenditure is developed, demonstrating the proportion of users that exceed any given annual expenditure and the proportion of total expenditures comprised by spending in excess of that "deductible."</p><p>authors: N/A</p><p>issue_mesh: Ambulatory Care/economics : Data Collection : Human : Insurance, Pharmaceutical Services/utilization : Medicare/utilization : Prescriptions, Drug/economics : Statistics : United States</p><p>issue_number: 1</p><p>ntis_number: PB88-160221</p><p>page_range: 83-89</p><p>primary_author: Waldo, Daniel R</p><p>title: Outpatient prescription drug spending by the Medicare population.</p><p>volume: 9</p><p>year_period: 1987 Fall</p>]]></description></item><item><title>Health spending in the 1980's: integration of clinical practice patterns with management.</title><pubDate>Mon, 04 Nov 2019 02:27:52 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191860</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191860</guid><description><![CDATA[<p>abstract: Health care spending in the United States more than tripled between 1972 and 1982, increasing from $94 billion to $322 billion. This growth substantially outpaced overall growth in the economy. National health expenditures are projected to reach approximately $690 billion in 1990 and consume roughly 12 percent of the gross national product. Government spending for health care is projected to reach $294 billion by 1990, with the Federal Government paying 72 percent. The Medicare prospective payment system and increasing competition in the health services sector are providing incentives to integrate clinical practice patterns with improved management practices.</p><p>authors: Schendler, Carol E</p><p>issue_mesh: Delivery of Health Care/economics : Economics, Hospital/trends : Europe : Health Expenditures/trends : Medicare/trends : Statistics : United States</p><p>issue_number: 3</p><p>ntis_number: PB84-189844</p><p>page_range: 1-68</p><p>primary_author: Freeland, Mark S</p><p>title: Health spending in the 1980's: integration of clinical practice patterns with management.</p><p>volume: 5</p><p>year_period: 1984 Spring</p>]]></description></item><item><title>Incentives in case-mix measures for long-term care.</title><pubDate>Mon, 04 Nov 2019 02:27:52 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191894</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191894</guid><description><![CDATA[<p>abstract: Several States now use patient-based payments for skilled nursing facilities and intermediate care facilities; others are in the process of developing case-mix systems. The Health Care Financing Administration is working under congressional mandate to develop a prospective case-mix system for Medicare payments to skilled nursing facilities. If new payment methods follow the existing pattern, they will be based not on the patient's clinical characteristics but rather on a mixture of clinical characteristics and services delivered. As a result, innate incentives are contained in data collection systems which are cost-increasing at best and dangerous at worst. A preferable approach would be to develop payment schemes based on the patient's degree of dependence.</p><p>authors: N/A</p><p>issue_mesh: Costs and Cost Analysis : Diagnosis-Related Groups : Intermediate Care Facilities/economics : Medicare : Nursing Homes/economics : Prospective Payment System/methods : Reimbursement Mechanisms/methods : Skilled Nursing Facilities/economics : United States : United States Health Care Financing Administration : West Virginia</p><p>issue_number: 2</p><p>ntis_number: PB85-155075</p><p>page_range: 53-59</p><p>primary_author: Smits, Helen L</p><p>title: Incentives in case-mix measures for long-term care.</p><p>volume: 6</p><p>year_period: 1984 Winter</p>]]></description></item><item><title>Medicare physicians' services: the composition of spending and assignment rates.</title><pubDate>Mon, 04 Nov 2019 02:27:52 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191934</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191934</guid><description><![CDATA[<p>abstract: Medicare spending for physicians' services, the second largest component of the Medicare program (24.5 percent), represents 1.3 percent of the Federal budget, 0.41 percent of the gross national product, and 19.4 percent of national spending for physicians' services. Interest in reforming the Medicare physician payment system is growing. Detailed information on patterns of Medicare spending for physicians' services and assignment rates according to physician specialty, place of service, type of service, and procedure are presented here.</p><p>authors: Schieber, George J</p><p>issue_mesh: Fees, Medical : Income : Medicare/economics : Rate Setting and Review/methods : Specialties, Medical/economics : United States</p><p>issue_number: 1</p><p>ntis_number: PB86-156759</p><p>page_range: 81-96</p><p>primary_author: Burney, Ira L</p><p>title: Medicare physicians' services: the composition of spending and assignment rates.</p><p>volume: 7</p><p>year_period: 1985 Fall</p>]]></description></item><item><title>An overview of long-term care.</title><pubDate>Mon, 04 Nov 2019 02:27:52 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191904</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191904</guid><description><![CDATA[<p>abstract: Long-term care (LTC) refers to health, social, and residential services provided to chronically disabled persons over an extended period of time. Especially during the last 20 years, State and Federal Governments have played an increasing role in the financing of long-term care. The aging of the population underlines the future importance of this topic. This article provides background data on need, supply, and expenditures; discusses government financing programs; and addresses quality of care concerns and options for LTC reform.</p><p>authors: Liu, Korbin; Wiener, Joshua</p><p>issue_mesh: Aged : Female : Financing, Government/trends : Health Expenditures/trends : Health Services Needs and Demand/trends : Human : Long-Term Care/economics : Male : Medicaid : Medicare : Population : United States</p><p>issue_number: 3</p><p>ntis_number: PB85-226165</p><p>page_range: 69-78</p><p>primary_author: Doty, Pamela</p><p>title: An overview of long-term care.</p><p>volume: 6</p><p>year_period: 1985 Spring</p>]]></description></item><item><title>Private health insurance: new measures of a complex and changing industry.</title><pubDate>Mon, 04 Nov 2019 02:27:51 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191892</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191892</guid><description><![CDATA[<p>abstract: Private health insurance benefit payments are an integral component of estimates of national health expenditures. Recent analyses indicate that the insurance industry has undergone significant changes since the mid-1970's. As a result of these study findings and corresponding changes to estimating techniques, private health insurance estimates have been revised upward. This has had a major impact on national health expenditure estimates. This article describes the changes that have occurred in the industry, discusses some of the implications of those changes, presents a new methodology to measure private health insurance and the resulting estimate levels, and then examines concepts that underpin these estimates.</p><p>authors: Trapnell, Gordon R</p><p>issue_mesh: Evaluation Studies : Fees and Charges/trends : Health Expenditures/trends : Insurance, Health/classification : Methods : United States</p><p>issue_number: 2</p><p>ntis_number: PB85-155075</p><p>page_range: 31-42</p><p>primary_author: Arnett 3d, Ross H</p><p>title: Private health insurance: new measures of a complex and changing industry.</p><p>volume: 6</p><p>year_period: 1984 Winter</p>]]></description></item><item><title>Factors affecting appropriateness of hospital use in Massachusetts.</title><pubDate>Mon, 04 Nov 2019 02:27:51 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191980</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191980</guid><description><![CDATA[<p>abstract: To determine the extent of inappropriate hospital use, and to investigate factors related to variations in appropriateness, 8,031 hospital records of patients discharged from 41 hospitals in 3 Massachusetts professional standards review organization (PSRO) areas were reviewed in 1973 and 1978. The Appropriateness Evaluation Protocol (AEP) was used for the reviews and logistic regression analysis was used to analyze factors associated with inappropriate use. Based on the results, the authors conclude that utilization review should focus on: longer stays among surgical patients and shorter stays among medical patients; (projected) last third of the stay; and on diagnoses or diagnosis-related groups in which there is less clinical consensus on treatment method. For maximum effectiveness, utilization review must include incentives beyond simple monitoring (e.g., financial incentives).</p><p>authors: Dayno, Susan J; Gertman, Paul M; Kreger, Bernard E; Lenhart, Gregory M; Payne, Susan M</p><p>issue_mesh: Professional Review Organizations : Data Collection : Health Services Misuse : Hospitals/utilization : Massachusetts : Statistics : Support, U.S. Gov't, Non-P.H.S. : Utilization Review/methods</p><p>issue_number: 1</p><p>ntis_number: PB88-131545</p><p>page_range: 47-54</p><p>primary_author: Restuccia, Joseph D</p><p>title: Factors affecting appropriateness of hospital use in Massachusetts.</p><p>volume: 8</p><p>year_period: 1986 Fall</p>]]></description></item><item><title>A framework for analyzing prospective payment system rate-increase factors.</title><pubDate>Mon, 04 Nov 2019 02:27:51 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191913</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191913</guid><description><![CDATA[<p>authors: Cocotas, Carolyn; Freeland, Mark S; Kowalczyk, George I</p><p>issue_mesh: Cost-Benefit Analysis : Diagnosis-Related Groups/economics : Efficiency : Models, Theoretical : Prospective Payment System/methods : Rate Setting and Review/methods : Reimbursement Mechanisms/methods : United States</p><p>issue_number: 4</p><p>ntis_number: PB86-139409</p><p>page_range: 135-141</p><p>primary_author: Arnett 3d, Ross H</p><p>title: A framework for analyzing prospective payment system rate-increase factors.</p><p>volume: 6</p><p>year_period: 1985 Summer</p>]]></description></item><item><title>Uninsured spells of the poor: prevalence and duration.</title><pubDate>Mon, 04 Nov 2019 02:27:51 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191515</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191515</guid><description><![CDATA[<p>abstract: The number of persons without health insurance is increasing. Although research has focused on the uninsured poor and the duration of spells without health insurance, less attention has been paid to the dynamics of spells without health insurance among those in poverty. Here it is shown that the typical uninsured spell is longer for the uninsured poor (roughly 8.3 months) than for the uninsured non-poor (roughly 6 months) and that the duration of spells has increased over time. In addition, more than 40 percent of the uninsured at a point in time are chronically uninsured and poor or near-poor.</p><p>authors: N/A</p><p>issue_mesh: Adolescence : Adult : Aged : Demography : Female : Health Care Surveys : Health Policy : Human : Longitudinal Studies : Male : Medically Uninsured/statistics &#x26; numerical data : Middle Age : Poverty/statistics &#x26; numerical data : Support, U.S. Gov't, Non-P.H.S. : Time Factors : United States/epidemiology</p><p>issue_number: 1</p><p>ntis_number: PB99-109621</p><p>page_range: 145-160</p><p>primary_author: McBride, Timothy D</p><p>title: Uninsured spells of the poor: prevalence and duration.</p><p>volume: 19</p><p>year_period: 1997 Fall</p>]]></description></item><item><title>Relative intensity measures: pricing the inpatient nursing services under diagnosis-related group prospective hospital payment.</title><pubDate>Mon, 04 Nov 2019 02:27:51 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191889</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191889</guid><description><![CDATA[<p>abstract: A sample survey (N = 2660) was conducted at eight acute care hospitals in New Jersey during an 11-month period between 1979 and 1981 in order to develop a client-focused, case-mix sensitive measure of resource use for the allocation of inpatient general nursing costs. Using general linear modeling techniques, the direct and indirect effects of age, length of stay, multiple diagnoses, multiple procedures, the ratio of special care unit days to length of stay, and the effects of the presence of surgery, admission status, discharge status, and membership in Major Diagnostic Categories on indexed total units of nursing service were explored. The results of the analysis suggested that length of stay is the most significant predictor of indexed nursing units of service regardless of age and the complexity of the medical problem when case-mix is controlled through the assignment of cases to 13 nursing services isoresource clusters. The methodology yields an empirically derived patient-specific, case-mix adjusted length of stay statistic which can be used to apportion nursing costs by the case. The approach permits the estimation of nursing units of service which reflect the relative amount of nursing inputs and corresponding costs of direct in any given hospital.</p><p>authors: N/A</p><p>issue_mesh: Costs and Cost Analysis : Diagnosis-Related Groups : Cost Allocation : Factor Analysis, Statistical : Length of Stay/economics : New Jersey : Nursing Service, Hospital/economics : Time and Motion Studies</p><p>issue_number: 1</p><p>ntis_number: PB85-124188</p><p>page_range: 61-70</p><p>primary_author: Caterinicchio, Russell P</p><p>title: Relative intensity measures: pricing the inpatient nursing services under diagnosis-related group prospective hospital payment.</p><p>volume: 6</p><p>year_period: 1984 Fall</p>]]></description></item><item><title>Nursing home costs for those dually entitled to Medicare and Medicaid.</title><pubDate>Mon, 04 Nov 2019 02:27:51 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192025</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1192025</guid><description><![CDATA[<p>abstract: The focus of this article is the impact of nursing home care on total Medicare and Medicaid expenditures for the aged population entitled to both programs. To determine these costs for 1981, data in the Health Care Financing Administration's Medicare Statistical System were linked, for the first time, to data in the Medicaid system for four States. Also examined are expenditure patterns for survivors and decedents using nursing home services. Results indicate that the two most significant factors influencing costs or the dually entitled elderly are the use of nursing home services and the costs of care in the last months of life. An unexpected finding was that of the 73 percent who neither died nor were in a nursing home, per capita expenditures were remarkedly constant across all age groups.</p><p>authors: Gornick, Marian; Howell, Embry M; Lubitz, James; Prihoda, Ronald; Rabey, Evelyne; Russell, Delores</p><p>issue_mesh: Health Expenditures : Aged : Aged, 80 and over : California : Data Collection : Georgia : Hospitals : Human : Medicaid/utilization : Medicare/utilization : Morbidity : New York : Nursing Homes/economics : Socioeconomic Factors : Statistics : Tennessee</p><p>issue_number: 2</p><p>ntis_number: PB88-196670</p><p>page_range: 1-14</p><p>primary_author: McMillan, Alma</p><p>title: Nursing home costs for those dually entitled to Medicare and Medicaid.</p><p>volume: 9</p><p>year_period: 1987 Winter</p>]]></description></item><item><title>The Severity of Illness Index as a severity adjustment to diagnosis-related groups.</title><pubDate>Mon, 04 Nov 2019 02:27:51 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191879</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191879</guid><description><![CDATA[<p>ntis_number: PB85-155083</p><p>page_range: 33-45</p><p>primary_author: Horn, Susan D</p><p>title: The Severity of Illness Index as a severity adjustment to diagnosis-related groups.</p><p>volume: Supp.</p><p>year_period: 1984 Supp.</p>]]></description></item><item><title>Out-of-plan use by Medicare enrollees in a risk-sharing health maintenance organization.</title><pubDate>Mon, 04 Nov 2019 02:27:51 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191940</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191940</guid><description><![CDATA[<p>abstract: In this study, we analyzed the cost and volume effects of a waiver that eliminated lock-in restrictions on out-of-plan use in a health maintenance organization (HMO) with a Medicare risk-sharing contract. We compared out-of-plan cost and number of claims during a 15-month base line period when the lock-in was in effect, with a 24-month waiver period when the lock-in was removed. The results demonstrate that average per capita cost and claims increased significantly for both Medicare Part A (hospital insurance) and Part B (supplementary medical insurance) out-of-plan services during the waiver. Self-referred out-of-plan use normally prohibited by lock-in, accounted for 20 percent of all out-of-plan costs during the waiver and 57 percent of the increase in out-of-plan costs from the lock-in to the waiver. The combination of risk-sharing and lock-in provisions holds promise as a method for reducing expenditures for the Medicare program.</p><p>authors: Diehr, Paula; Johnston, Ric; Martin, Diane P; Richardson, William C</p><p>issue_mesh: Health Maintenance Organizations : Costs and Cost Analysis : Emergencies : Health Services/utilization : Medicare/utilization : Pilot Projects : Statistics : Support, U.S. Gov't, Non-P.H.S. : Washington</p><p>issue_number: 2</p><p>ntis_number: PB86-198900</p><p>page_range: 39-49</p><p>primary_author: Haglund, Claudia L</p><p>title: Out-of-plan use by Medicare enrollees in a risk-sharing health maintenance organization.</p><p>volume: 7</p><p>year_period: 1985 Winter</p>]]></description></item><item><title>Disease staging: implications for hospital reimbursement and management.</title><pubDate>Mon, 04 Nov 2019 02:27:51 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191877</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191877</guid><description><![CDATA[<p>ntis_number: PB85-155083</p><p>page_range: 13-22</p><p>primary_author: Conklin, Jonathan E</p><p>title: Disease staging: implications for hospital reimbursement and management.</p><p>volume: Supp.</p><p>year_period: 1984 Supp.</p>]]></description></item><item><title>Medicaid nursing home reimbursement policies, rates, and expenditures.</title><pubDate>Mon, 04 Nov 2019 02:27:51 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191887</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191887</guid><description><![CDATA[<p>abstract: Nursing home expenditures, along with those of hospitals, have been a target of cost containment efforts because they constitute a growing share of overall public expenditures for health. Of the total $287 billion spent on personal health care in 1982, $27 billion (9.5 percent) was spent on nursing home care (Gibson, Waldo, and Levit, 1983). Nationally, nursing home expenditures increased at a rate of 17.4 percent between 1980 and 1981 and 12.9 percent between 1981 and 1982, more rapidly than overall health care expenditures (Gibson, Waldo, and Levit, 1983).</p><p>authors: Swan, James H</p><p>issue_mesh: Reimbursement Mechanisms : Comparative Study : Medicaid/trends : Nursing Homes/economics : Rate Setting and Review : Regression Analysis : Support, U.S. Gov't, P.H.S. : United States</p><p>issue_number: 1</p><p>ntis_number: PB85-124188</p><p>page_range: 39-49</p><p>primary_author: Harrington, Charlene</p><p>title: Medicaid nursing home reimbursement policies, rates, and expenditures.</p><p>volume: 6</p><p>year_period: 1984 Fall</p>]]></description></item><item><title>Toward a better understanding of hospital occupancy rates.</title><pubDate>Mon, 04 Nov 2019 02:27:51 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191873</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191873</guid><description><![CDATA[<p>abstract: This article starts out with the premise that a "uniform occupancy rate" for hospitals is not a meaningful concept because the ability of individual hospitals to maintain a certain occupancy rate consistent with a specified "protection level" depends upon several factors. These factors include hospital size, the number of nonsubstitutable patient facilities, the percent of nonurgent (elective) beds, the number of hospitals serving an area, and the relative variation (fluctuation) in the demand for services faced by the hospital. A regression analysis with observed, overall occupancy rate as the dependent variable, and measures that attempt to represent the factors just mentioned as independent variables, tends to substantiate this line of reasoning. However, inasmuch as the status of the independent variables (that is, whether or not they can be regarded as justifiable or uncontrollable) depends largely on the circumstances of each case, the regression model cannot be used as a standard-setting tool. Nonetheless, it offers valuable guidelines for hospital management, planners, and regulators in such areas of decisionmaking as the location and size of hospitals, and acceptable occupancy standards.</p><p>authors: Andes, Steven; Mullner, Ross</p><p>issue_mesh: Bed Occupancy : California : Comparative Study : Hospitals, Community/utilization : Regression Analysis : United States</p><p>issue_number: 4</p><p>ntis_number: PB84-229343</p><p>page_range: 53-61</p><p>primary_author: Phillip, P Joseph</p><p>title: Toward a better understanding of hospital occupancy rates.</p><p>volume: 5</p><p>year_period: 1984 Summer</p>]]></description></item><item><title>Demographic characteristics and health care use and expenditures by the aged in the United States: 1977-1984.</title><pubDate>Mon, 04 Nov 2019 02:27:51 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191885</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191885</guid><description><![CDATA[<p>abstract: In recent years, increasing attention has been given to the use and financing of health care for the aged. The authors of this article summarize much of the data related to that use, and present original estimates of health spending in 1984 on behalf of the aged. The estimates are designed to indicate trends in health expenditures and are tied to aggregate personal health care expenditures from the National Health Accounts.</p><p>authors: Lazenby, Helen C</p><p>issue_mesh: Aged : Comparative Study : Data Collection : Health Expenditures/trends : Health Services for the Aged/utilization : Health Status Indicators : Human : Medicare/utilization : Socioeconomic Factors : United States</p><p>issue_number: 1</p><p>ntis_number: PB85-124188</p><p>page_range: 1-30</p><p>primary_author: Waldo, Daniel R</p><p>title: Demographic characteristics and health care use and expenditures by the aged in the United States: 1977-1984.</p><p>volume: 6</p><p>year_period: 1984 Fall</p>]]></description></item><item><title>Research issues: Dually eligible Medicare and Medicaid beneficiaries, challenges and opportunities</title><pubDate>Mon, 04 Nov 2019 02:27:51 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191556</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191556</guid><description><![CDATA[<p>issue_number: 2</p><p>ntis_number: PB2000-102915</p><p>page_range: 1-10</p><p>primary_author: Clark, William D</p><p>title: Research issues: Dually eligible Medicare and Medicaid beneficiaries, challenges and opportunities</p><p>volume: 20</p><p>year_period: 1998 Winter</p>]]></description></item><item><title>Trends in nursing home expenditures: implications for aging policy.</title><pubDate>Mon, 04 Nov 2019 02:27:51 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191594</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191594</guid><description><![CDATA[<p>abstract: Nursing home care has become a major governmental responsibility. Public expenditures for nursing home care amounted to $7.3 billion in 1977. They represented 57.2 percent of the $12.8 billion nursing home bill nationally and 12 percent of public spending on all personal health care. Nursing home care absorbs more than one-third of all Medicaid expenditures. This paper explores expenditure patterns in recent years and discusses some of the factors that will influence these patterns in the future. First we analyze recent trends over the five-year period ending 1977. Then we project future utilization based on current age-specific use rates. Finally, we review recent studies on the potential cost of savings of noninstitutional alternatives to nursing home care.</p><p>authors: Clauser, Steven B</p><p>issue_mesh: Health Policy : Aged : Health Expenditures/trends : Human : Nursing Homes/utilization : Statistics : United States</p><p>issue_number: 2</p><p>ntis_number: HRP-0902942</p><p>page_range: 65-70</p><p>primary_author: Fox, Peter D</p><p>title: Trends in nursing home expenditures: implications for aging policy.</p><p>volume: 2</p><p>year_period: 1980 Fall</p>]]></description></item><item><title>Duration in and pattern of utilization under children's health insurance programs.</title><pubDate>Mon, 04 Nov 2019 02:27:51 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191544</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191544</guid><description><![CDATA[<p>abstract: This article provides information on duration of enrollment and utilization under children's health insurance programs for States planning to expand such programs in response to the Balanced Budget Act of 1997. Using data from children's health insurance programs in Pennsylvania, we find that there is a significant turnover among enrollees and the pattern of use following enrollment suggests considerable pent-up demand for medical services. The annual payment per child for services with a comprehensive benefit package in 1994-95 was estimated to range from $500 to $600 depending on turnover, which is a slight underestimation because some hospitalized children were shifted to Medicaid.</p><p>authors: Lave, Judith R</p><p>issue_mesh: Child : Evaluation Studies : Factor Analysis, Statistical : Human : Medicaid/economics/utilization : Multivariate Analysis : Survival Analysis : United States</p><p>issue_number: 4</p><p>ntis_number: PB2000-102913</p><p>page_range: 101-116</p><p>primary_author: Lin, Chyongchiou J</p><p>title: Duration in and pattern of utilization under children's health insurance programs.</p><p>volume: 19</p><p>year_period: 1998 Summer</p>]]></description></item><item><title>Effect of low-income elderly insurance copayment subsidies.</title><pubDate>Mon, 04 Nov 2019 02:27:51 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191558</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191558</guid><description><![CDATA[<p>abstract: The authors use a two-part model of demand to model the impact of qualified Medicare beneficiary (QMB) enrollment on medical care use. Assuming QMB enrollment to be exogenous, they find Medicare Part B utilization to be 12 percent higher and Part B expenditures 44 percent greater among QMBs than among eligible non-enrollees. There is no difference between these two groups in overall Part A expenditures. Modeling the possibility that QMB enrollment is endogenous, the authors find qualitatively similar results, but the estimates are not precisely estimated.</p><p>authors: Evans, William N</p><p>issue_mesh: Economics : Eligibility Determination/economics : Human : Medicaid : Medicare Part A/economics/statistics &#x26; numerical data/utilization : Medicare Part B/economics/statistics &#x26; numerical data/utilization : Models, Econometric : Poverty : Social Security : United States</p><p>issue_number: 2</p><p>ntis_number: PB2000-102915</p><p>page_range: 19-37</p><p>primary_author: Parente, Stephen T</p><p>title: Effect of low-income elderly insurance copayment subsidies.</p><p>volume: 20</p><p>year_period: 1998 Winter</p>]]></description></item><item><title>The Bedford-Stuyvesant/Crown Heights demonstration project.</title><pubDate>Mon, 04 Nov 2019 02:27:51 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191874</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191874</guid><description><![CDATA[<p>abstract: The Bedford-Stuyvesant/Crown Heights demonstration project in Brooklyn, New York, provided Federal and New York State funds to offset the deficits of three hospitals and three freestanding health centers while the six institutions worked to improve service quality and financial viability of the local health care system. The demonstration project resulted in a merger between two of the participants: at the end of 1982, the Jewish Hospital and Medical Center of Brooklyn and St. John's Episcopal Hospital of Brooklyn merged to form Interfaith Medical Center.</p><p>authors: Lee, A James; Venable, Ann</p><p>issue_mesh: Community Health Centers/economics : Cost Control/methods : Financial Management, Hospital/methods : Financial Management/methods : Health Facility Merger/economics : Hospitals, Municipal/economics : Hospitals, Public/economics : Multi-Institutional Systems/organization &#x26; administration : New York City : Pilot Projects : Support, U.S. Gov't, Non-P.H.S.</p><p>issue_number: 4</p><p>ntis_number: PB84-229343</p><p>page_range: 63-69</p><p>primary_author: Wolfe, Harry B</p><p>title: The Bedford-Stuyvesant/Crown Heights demonstration project.</p><p>volume: 5</p><p>year_period: 1984 Summer</p>]]></description></item><item><title>Nursing home levels of care: problems and alternatives.</title><pubDate>Mon, 04 Nov 2019 02:27:51 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191591</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191591</guid><description><![CDATA[<p>abstract: Providers and recipients of nursing home care under Medicaid are currently classified into two levels of care to facilitate appropriate placement, care, and reimbursement. The inherent imprecision of the two level system leads to problems of increased cost to Medicaid, lowered quality of care, and inadequate access to care for Medicaid recipients. However, a more refined system is likely to encounter difficulties in carrying out the functions performed by the broad two-level system, including assessment of residents, prescription of needed services, and implementation of service plans. The service type-service intensity classification proposed here can work in combination with a three-part reimbursement rate to encourage more accurate matching of resident needs, services, and Medicaid payment, while avoiding disruption of care.</p><p>authors: Plough, Alonzo L; Willemain, Thomas R</p><p>issue_mesh: Health Services Accessibility : Chronic Disease/classification : Medicaid/economics : Nursing Homes/classification : Patient Care Planning : Reimbursement Mechanisms : United States</p><p>issue_number: 2</p><p>ntis_number: HRP-0902942</p><p>page_range: 33-45</p><p>primary_author: Bishop, Christine E</p><p>title: Nursing home levels of care: problems and alternatives.</p><p>volume: 2</p><p>year_period: 1980 Fall</p>]]></description></item><item><title>Children's use of primary and preventive care under Medicaid managed care.</title><pubDate>Mon, 04 Nov 2019 02:27:51 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191541</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191541</guid><description><![CDATA[<p>abstract: The authors found that two mandatory Medicaid primary care case management (PCCM) programs were somewhat successful in improving access to primary care among children in the early 1990s. However, the Florida program, in which the PCCM benefit package included Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services, did not meaningfully increase EPSDT screening visits among preschoolers. Further, the increase seen in New Mexico, where EPSDT was carved out of the PCCM benefit package, was evident for both program participants and non-participants and therefore could not be attributed to the PCCM program.</p><p>authors: Ferrelly, Matthew C; Simpson Jr, Joe B</p><p>issue_mesh: Child : Medicaid : Child, Preschool : Evaluation Studies : Florida : Human : Multivariate Analysis : New Mexico : Preventive Health Services/utilization : Primary Health Care/utilization : United States</p><p>issue_number: 4</p><p>ntis_number: PB2000-102913</p><p>page_range: 45-68</p><p>primary_author: Gavin, Norma I</p><p>title: Children's use of primary and preventive care under Medicaid managed care.</p><p>volume: 19</p><p>year_period: 1998 Summer</p>]]></description></item><item><title>Mental health of Medicare beneficiaries: 1995.</title><pubDate>Mon, 04 Nov 2019 02:27:51 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191492</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191492</guid><description><![CDATA[<p>authors: Poisal, John A</p><p>issue_mesh: Aged : Alzheimer Disease/epidemiology : Health Expenditures/statistics &#x26; numerical data : Health Surveys : Human : Medicare/economics/statistics &#x26; numerical data : Mental Disorders/epidemiology : Mental Retardation/epidemiology : Nursing Homes/statistics &#x26; numerical data : United States/epidemiology</p><p>issue_number: 3</p><p>ntis_number: PB98-110554</p><p>page_range: 207-210</p><p>primary_author: Eppig, Franklin J</p><p>title: Mental health of Medicare beneficiaries: 1995.</p><p>volume: 18</p><p>year_period: 1997 Spring</p>]]></description></item><item><title>Changes in distribution of Medicare expenditures among aged enrollees, 1969-82.</title><pubDate>Mon, 04 Nov 2019 02:27:50 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191947</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191947</guid><description><![CDATA[<p>abstract: In this article, we examined the concentration of Medicare expenditures among the aged for 1969, 1975, and 1982 to determine if expenditures have become more concentrated among a few heavy users of service over time. Despite an increase in reimbursements for the aged from $6.0 billion in 1969 to $41.8 billion in 1982, the distribution of those expenses remained remarkably stable, with a slight lessening in the concentration of reimbursements in 1982. Patterns were similar for both Part A (hospital insurance) and Part B (supplementary medical insurance) services. The concentration of expenditures was much greater among survivors than among people who died in both 1975 and 1982, with little change in the distribution of expenditures within either group.</p><p>authors: Lubitz, James; Prihoda, Ronald; Stevenson, Mary A</p><p>issue_mesh: Aged : Data Collection : Deductibles and Coinsurance : Health Expenditures/trends : Human : Medicare/utilization : Statistics : United States</p><p>issue_number: 3</p><p>ntis_number: PB86-217973</p><p>page_range: 53-63</p><p>primary_author: Riley, Gerald F</p><p>title: Changes in distribution of Medicare expenditures among aged enrollees, 1969-82.</p><p>volume: 7</p><p>year_period: 1986 Spring</p>]]></description></item><item><title>Pricing strategies for capitated delivery systems.</title><pubDate>Mon, 04 Nov 2019 02:27:50 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191965</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191965</guid><description><![CDATA[<p>ntis_number: PB88-131552</p><p>page_range: 35-44</p><p>primary_author: Gruenberg, Leonard</p><p>title: Pricing strategies for capitated delivery systems.</p><p>volume: Supp.</p><p>year_period: 1986 Supp.</p>]]></description></item><item><title>Health status and utilization: differences by Medicaid coverage and income.</title><pubDate>Mon, 04 Nov 2019 02:27:50 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191953</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191953</guid><description><![CDATA[<p>abstract: By several measures of health status, the Medicaid population is in worse health than are persons without Medicaid. In addition, poor persons without Medicaid coverage are in poorer health than those who are not poor. Use of health services among those in poor health shows Medicaid eligibles use services at a level comparable to those who are not poor and without Medicaid. Among the poor without Medicaid, the reduced likelihood of seeing a physician and purchasing a prescribed drug indicates the importance of Medicaid coverage in obtaining access to care.</p><p>authors: N/A</p><p>issue_mesh: Health : Health Services Needs and Demand : Health Services Research : Health Status : Age Factors : Data Collection : Health Services Accessibility : Health Services/utilization : Human : Medicaid/utilization : Poverty : United States</p><p>issue_number: 4</p><p>ntis_number: PB86-241262</p><p>page_range: 1-18</p><p>primary_author: Kasper, Judith D</p><p>title: Health status and utilization: differences by Medicaid coverage and income.</p><p>volume: 7</p><p>year_period: 1986 Summer</p>]]></description></item><item><title>General health of end stage renal disease program beneficiaries.</title><pubDate>Mon, 04 Nov 2019 02:27:50 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191514</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191514</guid><description><![CDATA[<p>abstract: A telephone survey of a national sample of 515 Medicare End Stage Renal Disease Program beneficiaries was conducted to obtain information on their health status and its determinants. The Medical Outcomes Study Short Form-36 (SF-36) was applied during the interview process to obtain the health-status information. The reliability of each SF-36 health-status dimension was at least 0.85, and the validity of seven of the eight dimensions was high. Weighted least-squares regression results showed that health-status levels were often lower among older patients and Hispanic persons, and sometimes lower for those with low incomes. The implications of using the SF-36 for health-status measurement are also described.</p><p>authors: Hassol, Andrea; Murphy, Michael; White, Alan J</p><p>issue_mesh: Health Status Indicators : Kidney Failure, Chronic : Treatment Outcome : Activities of Daily Living : Adult : Age Factors : Aged : Ethnic Groups : Female : Health Surveys : Hemodialysis/utilization : Human : Male : Medicare : Middle Age : Social Class : Support, U.S. Gov't, P.H.S. : United States/epidemiology</p><p>issue_number: 1</p><p>ntis_number: PB99-109621</p><p>page_range: 121-144</p><p>primary_author: Ozminkowski, Ronald J</p><p>title: General health of end stage renal disease program beneficiaries.</p><p>volume: 19</p><p>year_period: 1997 Fall</p>]]></description></item><item><title>Cost of care for cancer in a health maintenance organization.</title><pubDate>Mon, 04 Nov 2019 02:27:50 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191500</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191500</guid><description><![CDATA[<p>abstract: The direct costs of medical care for cancer are examined at Kaiser Permanente (KP) in Northern California. Use data from July 1987 through June 1991 were obtained from KP automated files for all 21,977 KP patients in the Bay Area SEER registry with cancer at one of seven cancer sites. Medical charts were reviewed for a stratified sample of 886 patients. Costs were estimated for initial, continuing, and terminal care, and for all person time within 15 years of diagnosis, by stage at diagnosis. From diagnosis until death or 15 years, long-term costs attributable to cancer were as follows: breast, $35,000; colon, $42,000; rectum, $51,000; lung, $33,000; ovarian, $64,000; prostate, $29,000; and Non-Hodgkin's Lymphoma (NHL), $48,000. The utilization and cost results reported here may be useful in assessing the cost-effectiveness of cancer prevention and control programs, in adjusting capitation rates and budgets, and in estimating the aggregate medical care costs attributable to cancer.</p><p>authors: Baer, David; Brown, Martin L; Jacobson, Alice S; Potosky, Arnold L; Quesenberry, Charles P; Somkin, Carol P; West, Dee</p><p>issue_mesh: Cost of Illness : Ambulatory Care/utilization : California : Demography : Health Care Costs/statistics &#x26; numerical data : Health Maintenance Organizations/economics : Hospitalization : Human : Medical Audit : Neoplasms/classification/economics : San Francisco : SEER Program : Support, U.S. Gov't, P.H.S.</p><p>issue_number: 4</p><p>ntis_number: PB99-109613</p><p>page_range: 51-76</p><p>primary_author: Fireman, Bruce H</p><p>title: Cost of care for cancer in a health maintenance organization.</p><p>volume: 18</p><p>year_period: 1997 Summer</p>]]></description></item><item><title>Effects of the Medicare Alzheimer s disease demonstration on Medicare expenditures</title><pubDate>Mon, 04 Nov 2019 02:27:50 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191576</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191576</guid><description><![CDATA[<p>abstract: Applicants were randomized either into a group with a limited Medicare community care service benefit and case management or into a control group receiving their regular medical care. Analyses assess whether or not community care management affected health care use. A tendency toward reduced expenditures was observed for the treatment group, combining all demonstration sites, and when observing each separately. These differences were or approached statistical significance in two sites for Medicare Part A and Parts A and B expenditures averaged over 3 years. Expenditure reductions approached budget neutrality with program costs in two sites.</p><p>authors: Clay, Ted; Fox, Patrick; Miller, Robert H</p><p>issue_mesh: Case Management : Health Expenditures : Program Evaluation : Aged : Alzheimer Disease/economics : Data Collection : Evaluation Studies : Medicare/economics/utilization : Regression Analysis : Support, U.S. Gov't, non-P.H.S. : United States</p><p>issue_number: 4</p><p>ntis_number: PB2000-102444</p><p>page_range: 45-65</p><p>primary_author: Newcomer, Robert</p><p>title: Effects of the Medicare Alzheimer s disease demonstration on Medicare expenditures</p><p>volume: 20</p><p>year_period: 1999 Summer</p>]]></description></item><item><title>Economic aspects of drug substitution.</title><pubDate>Mon, 04 Nov 2019 02:27:50 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191903</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191903</guid><description><![CDATA[<p>abstract: One of the major directions of health policy is the attempt to contain expenditures on pharmaceuticals by encouraging substitution of generic for brand name drug products. Yet, a major marketing survey of prescribing and dispensing patterns in California in 1977 found relatively little drug substitution occurring, and in fact substitution of more expensive products occurred more frequently than did substitution of less expensive products. This article tests alternative models of pharmacy dispensing behavior to better explain substitution patterns and it estimates price functions to measure the extent to which cost savings on generic products are passed on to consumers.</p><p>authors: Schweitzer, Stuart O</p><p>issue_mesh: Therapeutic Equivalency : California : Legislation, Pharmacy : Models, Theoretical : Pharmaceutical Services/economics : Prescription Fees</p><p>issue_number: 3</p><p>ntis_number: PB85-226165</p><p>page_range: 59-68</p><p>primary_author: Salehi, Hossein</p><p>title: Economic aspects of drug substitution.</p><p>volume: 6</p><p>year_period: 1985 Spring</p>]]></description></item><item><title>Health spending trends in the 1980's: adjusting to financial incentives.</title><pubDate>Mon, 04 Nov 2019 02:27:50 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191899</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191899</guid><description><![CDATA[<p>abstract: Health expenditure growth is projected to moderate considerably during 1983-90, reaching $660 billion in 1990 and consuming over 11 percent of the gross national product. During 1973-83, spending for health care more than tripled, increasing from $103 billion to $355 billion and moving from 7.8 percent to 10.8 percent of the gross national product. Government spending for health care is projected to reach $284 billion by 1990, with the Federal Government paying 73 percent. The Medicare Prospective Payment System, private sector initiatives, and State and local government actions are providing incentives to substantially increase competition and cost effectiveness in health care provision.</p><p>authors: Cowell, Carol S; Davidoff, Laurence M; Freeland, Mark S</p><p>issue_mesh: Data Collection : Forecasting : Health Expenditures/trends : Inflation, Economic : Medicaid/trends : Medicare/trends : Population : United States</p><p>issue_number: 3</p><p>ntis_number: PB85-226165</p><p>page_range: 1-26</p><p>primary_author: Arnett 3d, Ross H</p><p>title: Health spending trends in the 1980's: adjusting to financial incentives.</p><p>volume: 6</p><p>year_period: 1985 Spring</p>]]></description></item><item><title>A research paradigm for severity for illness: issues for the diagnosis-related group system.</title><pubDate>Mon, 04 Nov 2019 02:27:50 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191883</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191883</guid><description><![CDATA[<p>ntis_number: PB85-155083</p><p>page_range: 79-90</p><p>primary_author: Gertman, Paul M</p><p>title: A research paradigm for severity for illness: issues for the diagnosis-related group system.</p><p>volume: Supp.</p><p>year_period: 1984 Supp.</p>]]></description></item><item><title>Shaping public policy from the perspective of a data builder.</title><pubDate>Mon, 04 Nov 2019 02:27:50 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191912</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191912</guid><description><![CDATA[<p>abstract: During the past six decades, data analysis and research studies have been instrumental in shaping public and private health care policy. Policymakers obtain the knowledge they need for making policy decisions through exposure to and examination of data generated through research studies, experimentation, demonstrations, and analyses. In this article, U.S. hospital care policy has been divided into phases. As the development of health care policy has progressed in each phase, decisionmakers have consistently increased their reliance on data.</p><p>authors: Bialek, Ronald</p><p>issue_mesh: Information Systems : Policy Making : Health Policy/history : History of Medicine, 20th Cent. : Hospital Planning/history : United States</p><p>issue_number: 4</p><p>ntis_number: PB86-139409</p><p>page_range: 117-134</p><p>primary_author: Dobson, Allen</p><p>title: Shaping public policy from the perspective of a data builder.</p><p>volume: 6</p><p>year_period: 1985 Summer</p>]]></description></item><item><title>Case mix, quality, and cost relationships in Colorado nursing homes.</title><pubDate>Mon, 04 Nov 2019 02:27:50 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191895</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191895</guid><description><![CDATA[<p>abstract: The analyses reported in this article assessed the cost, case mix, and quality interrelationships among Colorado nursing homes. A unique set of patient-level data was collected specifically to measure case mix and quality. Case mix was found to be strongly associated with cost, accounting for up to 45 percent of the variation in cost per patient day. The relationship between quality and cost was weaker; quality variables accounted for only about 10 percent of the cost per day variation. Case mix was also associated with several facility characteristics found to be significant in other cost studies, suggesting that such facility characteristics serve as partial proxy measures for case mix. The cost-case mix relationships appear to be strong enough to justify incorporating case mix directly in nursing home reimbursement systems. In contrast, the weaker cost-quality association implies that it may not (yet) be appropriate to incorporate quality directly in reimbursement.</p><p>authors: Shaughnessy, Peter W</p><p>issue_mesh: Costs and Cost Analysis : Diagnosis-Related Groups : Colorado : Medicaid : Medicare : Nursing Homes/economics : Quality of Health Care/economics : Regression Analysis</p><p>issue_number: 2</p><p>ntis_number: PB85-155075</p><p>page_range: 61-71</p><p>primary_author: Schlenker, Robert E</p><p>title: Case mix, quality, and cost relationships in Colorado nursing homes.</p><p>volume: 6</p><p>year_period: 1984 Winter</p>]]></description></item><item><title>Building a better safety net.</title><pubDate>Mon, 04 Nov 2019 02:27:50 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191915</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191915</guid><description><![CDATA[<p>ntis_number: PB86-156551</p><p>page_range: 1</p><p>primary_author: Mills, Wilbur D</p><p>title: Building a better safety net.</p><p>volume: Supp.</p><p>year_period: 1985 Supp.</p>]]></description></item><item><title>Estimating the long-term care population: prevalence rates and selected characteristics.</title><pubDate>Mon, 04 Nov 2019 02:27:50 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191909</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191909</guid><description><![CDATA[<p>abstract: To facilitate manpower and service need estimates, the long-term care population must be defined in terms of dependency on human assistance in daily functioning. Such a definition of dependency is applied to national population data bases, using the 1977 National Nursing Home Survey and the 1977, 1979, and 1980 National Health Interview Surveys. The four categories of dependency are personal care, mobility, household activities, and home-administered health care services. Although projections to the year 2000 show a doubling of the nursing home population, estimates of the overall prevalence of functional dependency remain smaller than is popularly believed.</p><p>authors: N/A</p><p>issue_mesh: Health Services Needs and Demand : Health Services Research : Population : Activities of Daily Living : Data Collection : Long-Term Care/utilization : Support, U.S. Gov't, Non-P.H.S. : United States</p><p>issue_number: 4</p><p>ntis_number: PB86-139409</p><p>page_range: 83-91</p><p>primary_author: Weissert, William G</p><p>title: Estimating the long-term care population: prevalence rates and selected characteristics.</p><p>volume: 6</p><p>year_period: 1985 Summer</p>]]></description></item><item><title>Variation in resource use within diagnosis-related groups: the severity issue.</title><pubDate>Mon, 04 Nov 2019 02:27:50 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191882</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191882</guid><description><![CDATA[<p>ntis_number: PB85-155083</p><p>page_range: 71-88</p><p>primary_author: Smits, Helen L</p><p>title: Variation in resource use within diagnosis-related groups: the severity issue.</p><p>volume: Supp.</p><p>year_period: 1984 Supp.</p>]]></description></item><item><title>Physician losses from Medicare and Medicaid discounts: how real are they?</title><pubDate>Mon, 04 Nov 2019 02:27:50 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191907</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191907</guid><description><![CDATA[<p>abstract: Physicians' claims that extensive Medicare and Medicaid fee discounting imposes an inequitable burden on them are examined using survey data from the Health Care Financing Administration on 5,000 primary care physicians. A definite fee hierarchy is documented, with the physician's usual charge at the top and Medicare and Medicaid allowables at the bottom. Under usual, customary, and reasonable methods, physicians can use fees to maximize payment, and insurer attempts to control fees result in both sides participating in a revenue maximization-expenditure control game. Raising Medicare and Medicaid allowables to the physician's usual fee is shown to result in large windfall gains that are unnecessary and unjustified in terms of work effort, human capital investment, or eliciting an adequate supply of practitioners.</p><p>authors: Burstein, Philip</p><p>issue_mesh: Fee Schedules : Fees, Medical : Rate Setting and Review : Blue Shield : Comparative Study : Income : Medicaid/economics : Medicare/economics : Models, Theoretical : Specialties, Medical/economics : Support, U.S. Gov't, Non-P.H.S. : United States</p><p>issue_number: 4</p><p>ntis_number: PB86-139409</p><p>page_range: 51-68</p><p>primary_author: Cromwell, Jerry L</p><p>title: Physician losses from Medicare and Medicaid discounts: how real are they?</p><p>volume: 6</p><p>year_period: 1985 Summer</p>]]></description></item><item><title>Trends in physician assignment rates for Medicare services, 1968-85.</title><pubDate>Mon, 04 Nov 2019 02:27:50 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191942</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191942</guid><description><![CDATA[<p>abstract: This article provides an overview of trends in Medicare assignment rates. It covers changes over time in assignment by demographic characteristics and State and analyzes beneficiary liability. Although assignment rates were rising slowly from 1977 to 1983, beneficiary liability was also rising, primarily because of the rise in physician charges and the reduction on allowed charges. Substantial increases in the assignment rate have coincided with the implementation of provisions in the Deficit Reduction Act of 1984 to encourage assignment, and the assignment rate reached on all time high of 69 percent in 1985.</p><p>authors: Lubitz, James; Newton, Marilyn</p><p>issue_mesh: Physicians : Aged : Fees, Medical : Human : Insurance, Physician Services/trends : Medicare/trends : Statistics : Support, U.S. Gov't, Non-P.H.S. : United States : United States Health Care Financing Administration</p><p>issue_number: 2</p><p>ntis_number: PB86-198900</p><p>page_range: 59-75</p><p>primary_author: McMillan, Alma</p><p>title: Trends in physician assignment rates for Medicare services, 1968-85.</p><p>volume: 7</p><p>year_period: 1985 Winter</p>]]></description></item><item><title>Assessment of level of care: implications of interrater reliability on health policy.</title><pubDate>Mon, 04 Nov 2019 02:27:50 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191893</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191893</guid><description><![CDATA[<p>abstract: In Wisconsin, level-of-care assessments are used to set Medicaid reimbursement and determine nursing home eligibility. This study examined three methods of assessing level of care: 1) the Wisconsin quality assurance project (QAP) method, based on observations of patients, patient records, and staff interviews; 2) the Wisconsin standard (STD) method, based primarily on a clinical record review; and, 3) an adaptation of New York's "DMS-I," a checklist with numerical weights used to set level of care. Results address interrater reliability, the agreement between assessments by research teams and actual levels of care set by the State, and the implications that agreement has for reimbursement.</p><p>authors: Koningsveld, Richard V; Peterson, Robert W</p><p>issue_mesh: Costs and Cost Analysis : Diagnosis-Related Groups : Insurance, Health, Reimbursement : Nursing Homes/economics : Patient Care Planning/methods : Statistics : Support, U.S. Gov't, Non-P.H.S. : Wisconsin</p><p>issue_number: 2</p><p>ntis_number: PB85-155075</p><p>page_range: 43-51</p><p>primary_author: Gustafson, David H</p><p>title: Assessment of level of care: implications of interrater reliability on health policy.</p><p>volume: 6</p><p>year_period: 1984 Winter</p>]]></description></item><item><title>Physician pricing and health insurance reimbursement.</title><pubDate>Mon, 04 Nov 2019 02:27:49 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191858</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191858</guid><description><![CDATA[<p>authors: Der, William; Ernst, Richard L; Hay, Joel W</p><p>issue_mesh: Fees, Medical : Blue Shield/economics : Income : Insurance, Physician Services/economics : Medicare : Support, U.S. Gov't, P.H.S. : United States</p><p>issue_number: 2</p><p>ntis_number: PB84-185321</p><p>page_range: 69-80</p><p>primary_author: Yett, Donald E</p><p>title: Physician pricing and health insurance reimbursement.</p><p>volume: 5</p><p>year_period: 1983 Winter</p>]]></description></item><item><title>Evaluation of the Arizona health care cost-containment system.</title><pubDate>Mon, 04 Nov 2019 02:27:49 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191943</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191943</guid><description><![CDATA[<p>abstract: This article evaluates Arizona's alternative to the acute portion of Medicaid, the Arizona Health Care Cost-Containment System (AHCCCS), during its first 18 months of operation from October 1982 through March 1984. It focuses on the program's implementation and describes and evaluates the program's innovative features. The features of the program outlined in the original AHCCCS legislation included: Competitive bidding, prepaid capitation of providers, capitation of the State by the Health Care Financing Administration, assignment of gatekeepers, beneficiary copayment, private administration, inclusion of private and public employees and county financed long-term care. An assessment of implementation during the second 18 months of the program reporting on more recent developments and is now being prepared by SRI International.</p><p>authors: Crane, Michael; Freund, Deborah A; Haber, Susan; Henton, Douglas; Wrightson, William</p><p>issue_mesh: Contract Services : Financial Management : Arizona : Competitive Bidding : Evaluation Studies : Medicaid/organization &#x26; administration : Pilot Projects : Support, U.S. Gov't, Non-P.H.S. : United States : United States Health Care Financing Administration</p><p>issue_number: 2</p><p>ntis_number: PB86-198900</p><p>page_range: 77-88</p><p>primary_author: McCall, Nelda</p><p>title: Evaluation of the Arizona health care cost-containment system.</p><p>volume: 7</p><p>year_period: 1985 Winter</p>]]></description></item><item><title>Overview of Medicaid capitation and case-management initiatives.</title><pubDate>Mon, 04 Nov 2019 02:27:49 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191963</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191963</guid><description><![CDATA[<p>ntis_number: PB88-131552</p><p>page_range: 21-30</p><p>primary_author: Freund, Deborah A</p><p>title: Overview of Medicaid capitation and case-management initiatives.</p><p>volume: Supp.</p><p>year_period: 1986 Supp.</p>]]></description></item><item><title>Living arrangement choices of elderly singles: effects of income and disability.</title><pubDate>Mon, 04 Nov 2019 02:27:49 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191948</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191948</guid><description><![CDATA[<p>abstract: Logit regression is used to explain living arrangement choice of elderly single individuals. The propensity to live independently is found to increase with income and decrease with disability; an interaction effect for females suggests that income may lessen the impact of disability on the propensity to seek shared living arrangements. Independent living is less likely for people who are not white, foreign-born males, those with at least one adult child, and those in States with higher living costs; and more likely for the ever-married and those in States with high per capita nursing home use. If home care services are preferentially allocated to disabled elderly who live alone, resources may flow to higher income individuals who have been able to maintain independent households.</p><p>authors: N/A</p><p>issue_mesh: Activities of Daily Living : Single Person : Aged : Choice Behavior : Data Collection : Disabled Persons : Female : Human : Income : Male : Nursing Homes/utilization : Statistics : Support, U.S. Gov't, Non-P.H.S. : United States</p><p>issue_number: 3</p><p>ntis_number: PB86-217973</p><p>page_range: 65-73</p><p>primary_author: Bishop, Christine E</p><p>title: Living arrangement choices of elderly singles: effects of income and disability.</p><p>volume: 7</p><p>year_period: 1986 Spring</p>]]></description></item><item><title>The dually entitled elderly Medicare and Medicaid population living in the community.</title><pubDate>Mon, 04 Nov 2019 02:27:49 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191896</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191896</guid><description><![CDATA[<p>abstract: This study shows that the elderly living in the community and covered by Medicare and Medicaid have a higher proportion of older persons, of minority races, and of women and are in poorer health than other aged persons covered only by Medicare. The noninstitutionalized poor elderly population use more health care services (especially inpatient hospital care) and have much higher per capita health care expenses compared to those covered by Medicaid. There were also large disparities in education and income. The study indicates that the Medicare program provides substantially more financial protection for all elderly persons living in the community than for the total elderly population.</p><p>authors: Gornick, Marian</p><p>issue_mesh: Aged : Age Factors : Female : Health Services for the Aged/economics : Human : Male : Medicaid/utilization : Medicare/utilization : Sex Factors : Socioeconomic Factors : United States</p><p>issue_number: 2</p><p>ntis_number: PB85-155075</p><p>page_range: 73-85</p><p>primary_author: McMillan, Alma</p><p>title: The dually entitled elderly Medicare and Medicaid population living in the community.</p><p>volume: 6</p><p>year_period: 1984 Winter</p>]]></description></item><item><title>Outcomes of surgery among the Medicare aged: mortality after surgery.</title><pubDate>Mon, 04 Nov 2019 02:27:49 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191911</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191911</guid><description><![CDATA[<p>abstract: This study examines post-surgical mortality, up to 1 year after surgery, for eight common operations among aged Medicare enrollees. The operations with the highest mortality in the 1.5 months after surgery were femur fracture reduction, hip arthroplasty (other, i.e., not total replacement), and coronary artery bypass. Mortality was still above average for femur fracture reduction, hip arthroplasty (other), and transurethral prostatectomy 1 year after surgery. The highest mortality rates following surgery were for people 85 years of age or over. This raises the following question: Should certain elective surgery be performed at younger ages if it appears that surgery may eventually be needed?</p><p>authors: Newton, Marilyn; Riley, Gerald F</p><p>issue_mesh: Age Factors : Outcome and Process Assessment (Health Care) : Aged : Arthroplasty/mortality : Cholecystectomy/mortality : Coronary Artery Bypass/mortality : Female : Femur/surgery : Fracture Fixation, Internal/mortality : Hernia, Inguinal/surgery : Human : Male : Medicare : Postoperative Complications/mortality : Professional Practice : Prostatectomy/mortality : Surgical Procedures, Operative/mortality/standards : United States</p><p>issue_number: 4</p><p>ntis_number: PB86-139409</p><p>page_range: 103-115</p><p>primary_author: Lubitz, James</p><p>title: Outcomes of surgery among the Medicare aged: mortality after surgery.</p><p>volume: 6</p><p>year_period: 1985 Summer</p>]]></description></item><item><title>Health care expenditures for major diseases in 1980.</title><pubDate>Mon, 04 Nov 2019 02:27:49 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191868</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191868</guid><description><![CDATA[<p>abstract: Health care expenditures in the United States were 10.5 percent of the gross national product in 1982, and growing rapidly. The magnitude and continuing growth make health care costs an important issue in public policy. Knowledge of costs for specific diseases is necessary for ascertaining the effectiveness and efficiency of various health programs. In this article, medical care expenditures for major diseases are estimated from readily available data and it is shown that expenditures for more specific disease categories can be derived.</p><p>authors: Kopstein, Andrea N</p><p>issue_mesh: Age Factors : Comparative Study : Disease/economics : Female : Health Expenditures/classification : Human : Male : Personal Health Services/economics : Sex Factors : United States</p><p>issue_number: 4</p><p>ntis_number: PB84-229343</p><p>page_range: 1-12</p><p>primary_author: Hodgson, Thomas A</p><p>title: Health care expenditures for major diseases in 1980.</p><p>volume: 5</p><p>year_period: 1984 Summer</p>]]></description></item><item><title>Testing a diagnosis-related group index for skilled nursing facilities.</title><pubDate>Mon, 04 Nov 2019 02:27:49 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191958</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191958</guid><description><![CDATA[<p>abstract: Interest in case-mix measures for use in nursing home payment systems has been stimulated by the Medicare prospective payment system (PPS) for short-term acute-care hospitals. Appropriately matching payment with care needs is important to equitably compensate providers and to encourage them to admit patients who are most in need of nursing home care. The skilled nursing facility (SNF) Medicare benefit covers skilled convalescent or rehabilitative care following a hospital stay. Therefore, it might appear that diagnosis-related groups (DRG's), the basis for patient classification in PPS, could also be used for the Medicare SNF program. In this study, a DRG-based case-mix index (CMI) was developed and tested to determine how well it explains cost differences among SNF's. The results suggest that a DRG-based SNF payment system would be highly problematic. Incentives of this system would appear to discourage placement of patients who require relatively expensive care.</p><p>authors: N/A</p><p>issue_mesh: Chronic Disease/classification : Costs and Cost Analysis : Diagnosis-Related Groups/methods : Long-Term Care/classification : Medicare/economics : Skilled Nursing Facilities/economics : Statistics : United States</p><p>issue_number: 4</p><p>ntis_number: PB86-241262</p><p>page_range: 75-85</p><p>primary_author: Cotterill, Philip G</p><p>title: Testing a diagnosis-related group index for skilled nursing facilities.</p><p>volume: 7</p><p>year_period: 1986 Summer</p>]]></description></item><item><title>Medicare capitation and quality of care for the frail elderly.</title><pubDate>Mon, 04 Nov 2019 02:27:49 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191967</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191967</guid><description><![CDATA[<p>ntis_number: PB88-131552</p><p>page_range: 57-63</p><p>primary_author: Siu, Albert L</p><p>title: Medicare capitation and quality of care for the frail elderly.</p><p>volume: Supp.</p><p>year_period: 1986 Supp.</p>]]></description></item><item><title>National health expenditures, 1983.</title><pubDate>Mon, 04 Nov 2019 02:27:49 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191891</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191891</guid><description><![CDATA[<p>abstract: Although growing more slowly than in recent years, spending for health continued to account for an increasing share of the Nation's gross national product. In 1983, spending for health amounted to 10.8 percent of the gross national product, or $1,459 per person. Public programs financed 40 percent of all personal health care spending. Medicare and Medicaid expended $91 billion in benefits, 29 percent of all spending for personal health. New estimates of spending in calendar year 1983, along with revised measures of the benefits paid by private health insurers, are presented here.</p><p>authors: Lazenby, Helen C; Levit, Katharine R; Waldo, Daniel R</p><p>issue_mesh: Health Expenditures/trends : National Health Programs/economics : Personal Health Services/economics : Statistics : United States</p><p>issue_number: 2</p><p>ntis_number: PB85-155075</p><p>page_range: 1-30</p><p>primary_author: Gibson, Robert M</p><p>title: National health expenditures, 1983.</p><p>volume: 6</p><p>year_period: 1984 Winter</p>]]></description></item><item><title>How available are evening dialysis services?</title><pubDate>Mon, 04 Nov 2019 02:27:49 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191939</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191939</guid><description><![CDATA[<p>abstract: The availability of evening dialysis is considered important if the patient with renal failure is to return to work. Dialysis units are categorized by location and whether or not dialysis services are offered in the evening. The location of dialysis patients is compared with these estimates to determine the percentage of patients having access to evening dialysis either in their own dialysis units or in a unit in their market area. A very large proportion of patients in the working age groups are likely to have access to evening dialysis both in their own market area and in their own dialysis unit.</p><p>authors: Alexander, Victoria D</p><p>issue_mesh: Appointments and Schedules : Health Services Accessibility : Hemodialysis Units, Hospital/utilization : Hemodialysis, Home/utilization : Hemodialysis/supply &#x26; distribution : Night Care : Statistics : Support, U.S. Gov't, Non-P.H.S. : Time : United States</p><p>issue_number: 2</p><p>ntis_number: PB86-198900</p><p>page_range: 31-37</p><p>primary_author: Held, Philip J</p><p>title: How available are evening dialysis services?</p><p>volume: 7</p><p>year_period: 1985 Winter</p>]]></description></item><item><title>Setting health maintenance organization capitation rates for Medicaid in Wisconsin.</title><pubDate>Mon, 04 Nov 2019 02:27:49 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191957</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191957</guid><description><![CDATA[<p>abstract: In late fall 1984, more than 110,000 Wisconsin Aid to Families with Dependent Children (AFDC) Medicaid recipients were enrolled in health maintenance organizations (HMO's). Capitation rates were set by competitive bidding, subject to a rate ceiling. Planners considered whether to adjust the rates to account for demographic changes in the AFDC population between the time that data for the rate ceilings were collected and when the rates went into effect. They also considered whether to pay a single rate or to adjust rates for the age and sex of each HMO's actual enrollees. This article is a report of the analysis that led to a decision to pay a single, countywide rate that was not demographically adjusted.</p><p>authors: N/A</p><p>issue_mesh: Actuarial Analysis : Age Factors : Aid to Families with Dependent Children/economics : Capitation Fee/standards : Competitive Bidding : Fees and Charges/standards : Female : Health Maintenance Organizations/economics : Human : Male : Medicaid/economics : Rate Setting and Review/methods : Sex Factors : Wisconsin</p><p>issue_number: 4</p><p>ntis_number: PB86-241262</p><p>page_range: 67-73</p><p>primary_author: England, William L</p><p>title: Setting health maintenance organization capitation rates for Medicaid in Wisconsin.</p><p>volume: 7</p><p>year_period: 1986 Summer</p>]]></description></item><item><title>Symposium on data in a capitated environment. Introduction.</title><pubDate>Mon, 04 Nov 2019 02:27:49 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191969</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191969</guid><description><![CDATA[<p>ntis_number: PB88-131552</p><p>page_range: 75-77</p><p>primary_author: Lubitz, James</p><p>title: Symposium on data in a capitated environment. Introduction.</p><p>volume: Supp.</p><p>year_period: 1986 Supp.</p>]]></description></item><item><title>The valium project: diagnostic restrictions as a utilization control in a Medicaid drug program.</title><pubDate>Mon, 04 Nov 2019 02:27:49 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191866</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191866</guid><description><![CDATA[<p>abstract: This study examines the effectiveness of diagnosis restrictions as a drug utilization control in California's Medi-Cal (Medicaid) program. The numbers of Valium prescriptions dispensed, the numbers of Medi-Cal beneficiaries using Valium and the expenditures represented by those prescriptions were measured during application of a diagnosis restriction for a 33-month base period, followed by removal of the diagnosis restriction for a 14-month period.</p><p>authors: Keith, John C; Little, Daniel L</p><p>issue_mesh: California : Cost Control : Diazepam/therapeutic use : Drug and Narcotic Control : Drug Utilization/economics : Human : Medicaid/economics : Regression Analysis</p><p>issue_number: 3</p><p>ntis_number: PB84-189844</p><p>page_range: 133-138</p><p>primary_author: Boisseree, Victor R</p><p>title: The valium project: diagnostic restrictions as a utilization control in a Medicaid drug program.</p><p>volume: 5</p><p>year_period: 1984 Spring</p>]]></description></item><item><title>Medicaid program characteristics: effects on health care expenditures and utilization.</title><pubDate>Mon, 04 Nov 2019 02:27:49 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191938</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191938</guid><description><![CDATA[<p>abstract: Relationships between State Medicaid program characteristics and program outputs are analyzed in this statistical report, using 1980 cross-sectional data from a variety of sources. The year 1980 furnishes a baseline against which program changes following the Omnibus Budget Reconciliation Act of 1981 and the 1982 economic recession can be evaluated. Utilization and expenditures are modeled separately for each aid category and each major service category. This use of multiple models allows for measurement of the effect of program controls that might not appear in models of total utilization and expenditures.</p><p>authors: Buczko, William; Dobson, Allen; Mauskopf, Josephine; Rodgers, Jack</p><p>issue_mesh: Adult : Aid to Families with Dependent Children/economics : Child : Chronic Disease : Health Expenditures/trends : Health Services/utilization : Hospitals : Human : Medicaid/economics : Physicians : Poverty : Statistics : United States</p><p>issue_number: 2</p><p>ntis_number: PB86-198900</p><p>page_range: 1-30</p><p>primary_author: McDevitt, Roland D</p><p>title: Medicaid program characteristics: effects on health care expenditures and utilization.</p><p>volume: 7</p><p>year_period: 1985 Winter</p>]]></description></item><item><title>Personal health care expenditures, by State: 1966-82.</title><pubDate>Mon, 04 Nov 2019 02:27:49 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191906</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191906</guid><description><![CDATA[<p>abstract: Spending per capita for health care in the United States varies dramatically by State and region. In 1982, personal health care costs per capita ranged from a low of $857 in South Carolina to a high of $1,508 in Massachusetts. The focus of this article is State and regional variation in spending levels and the mix of health care services purchased. Possible causes for these differences are presented.</p><p>authors: N/A</p><p>issue_mesh: Catchment Area (Health) : Health Expenditures/trends : Personal Health Services/economics : Statistics : United States</p><p>issue_number: 4</p><p>ntis_number: PB86-139409</p><p>page_range: 1-50</p><p>primary_author: Levit, Katharine R</p><p>title: Personal health care expenditures, by State: 1966-82.</p><p>volume: 6</p><p>year_period: 1985 Summer</p>]]></description></item><item><title>Projections of health care spending to 1990.</title><pubDate>Mon, 04 Nov 2019 02:27:49 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191945</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191945</guid><description><![CDATA[<p>abstract: National health expenditures are projected to grow to $640 billion by 1990, 11.3 percent of the gross national product. Growth in health spending is expected to moderate to an 8.7 percent average annual rate from 1984 to 1990, compared with a 12.6 percent rate from 1978 to 1984. These projections assume lower estimates of overall economic price growth, lower use of hospital care, and increased use of less expensive types of care. A preliminary analysis of demographic factors reveals that the aging of the population has almost as great an impact as the growth in total population on projected expenditures for many types of health care services.</p><p>authors: Cowell, Carol S; McKusick, David R; Sonnefeld, Sally T</p><p>issue_mesh: Costs and Cost Analysis/trends : Economics, Hospital/trends : Financing, Organized/trends : Forecasting : Health Expenditures/trends : Health Manpower : Health Services/utilization : Models, Theoretical : Population Growth : Socioeconomic Factors : Statistics : United States</p><p>issue_number: 3</p><p>ntis_number: PB86-217973</p><p>page_range: 1-36</p><p>primary_author: Arnett 3d, Ross H</p><p>title: Projections of health care spending to 1990.</p><p>volume: 7</p><p>year_period: 1986 Spring</p>]]></description></item><item><title>The future of Medicare policy reform: priorities for research and demonstrations.</title><pubDate>Mon, 04 Nov 2019 02:27:49 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191961</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191961</guid><description><![CDATA[<p>ntis_number: PB88-131552</p><p>page_range: 1-8</p><p>primary_author: Dobson, Allen</p><p>title: The future of Medicare policy reform: priorities for research and demonstrations.</p><p>volume: Supp.</p><p>year_period: 1986 Supp.</p>]]></description></item><item><title>Changes in Medicare reimbursement in Colorado: impact on physicians' economic behavior.</title><pubDate>Mon, 04 Nov 2019 02:27:48 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191818</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191818</guid><description><![CDATA[<p>abstract: In 1976 there was a change in Medicare reimbursement policy in the State of Colorado. This study analyzes the impact of that change on physicians' economic behavior. Through 1976, prevailing charges (one of the determinants of the level of physician reimbursement under Medicare) were computed separately within each of 10 regions of Colorado. Since then, they have been computed for the State as a whole, and thus, physicians in like specialties have had equal prevailing charges throughout the State. This change in reimbursement policy led to a relative increase in prevailing charges for physicians in small urban and nonurban areas of the State, and a relative decrease for physicians in the major urban areas. In this paper we analyze the impact of this change on several aspects of physician behavior. We found that physicians whose reimbursement rates declined as a result of the change--primarily those in the Denver/Boulder area--provided more-intensive medical services, had lower assignment rates, and charged lower prices than they would have in the absence of the change.</p><p>authors: McCall, Nelda</p><p>issue_mesh: Insurance, Physician Services : Medicare : Reimbursement Mechanisms : Colorado : Comparative Study : Fees, Medical/trends : Rate Setting and Review : Regression Analysis : Support, U.S. Gov't, P.H.S.</p><p>issue_number: 4</p><p>ntis_number: PB82-219213</p><p>page_range: 67-85</p><p>primary_author: Rice, Thomas</p><p>title: Changes in Medicare reimbursement in Colorado: impact on physicians' economic behavior.</p><p>volume: 3</p><p>year_period: 1982 Jun</p>]]></description></item><item><title>Symposium: 20 Years of Medicare and Medicaid</title><pubDate>Mon, 04 Nov 2019 02:27:48 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191918</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191918</guid><description><![CDATA[<p>ntis_number: PB86-156551</p><p>page_range: 63-67</p><p>primary_author: Bristow, Lonnie R</p><p>title: Symposium: 20 Years of Medicare and Medicaid</p><p>volume: Supp.</p><p>year_period: 1985 Supp.</p>]]></description></item><item><title>Unrecognized redistributions of revenue in diagnosis-related group-based prospective payment systems.</title><pubDate>Mon, 04 Nov 2019 02:27:48 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191881</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191881</guid><description><![CDATA[<p>ntis_number: PB85-155083</p><p>page_range: 57-69</p><p>primary_author: Kominski, Gerald F</p><p>title: Unrecognized redistributions of revenue in diagnosis-related group-based prospective payment systems.</p><p>volume: Supp.</p><p>year_period: 1984 Supp.</p>]]></description></item><item><title>Incorporating severity of illness and comorbidity in case-mix measurement.</title><pubDate>Mon, 04 Nov 2019 02:27:48 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191878</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191878</guid><description><![CDATA[<p>ntis_number: PB85-155083</p><p>page_range: 23-31</p><p>primary_author: Young, Wanda W</p><p>title: Incorporating severity of illness and comorbidity in case-mix measurement.</p><p>volume: Supp.</p><p>year_period: 1984 Supp.</p>]]></description></item><item><title>Case-mix reimbursement for nursing home services: simulation approach.</title><pubDate>Mon, 04 Nov 2019 02:27:48 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191979</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191979</guid><description><![CDATA[<p>abstract: Nursing home reimbursement based on case mix is a matter of growing interest. Several States either use or are considering this reimbursement method. In this article, we present a method for evaluating key outcomes of such a change for Connecticut nursing homes. A simulation model is used to replicate payments under the case-mix systems used in Maryland, Ohio, and West Virginia. The findings indicate that, compared with the system presently used in Connecticut, these systems would better relate dollar payments to measure patient need, and for-profit homes would benefit relative to nonprofit homes. The Ohio methodology would impose the most additional costs, the West Virginia system would actually be somewhat less expensive in terms of direct patient care payments.</p><p>authors: Schlenker, Robert E</p><p>issue_mesh: Medicare : Computer Simulation : Connecticut : Diagnosis-Related Groups/economics : Health Services Research : Nursing Homes/economics : Prospective Payment System/organization &#x26; administration : Support, Non-U.S. Gov't : Support, U.S. Gov't, Non-P.H.S. : United States</p><p>issue_number: 1</p><p>ntis_number: PB88-131545</p><p>page_range: 35-45</p><p>primary_author: Adams, E Kathleen</p><p>title: Case-mix reimbursement for nursing home services: simulation approach.</p><p>volume: 8</p><p>year_period: 1986 Fall</p>]]></description></item><item><title>Quality of care review: recent experience in Arizona.</title><pubDate>Mon, 04 Nov 2019 02:27:48 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191968</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191968</guid><description><![CDATA[<p>ntis_number: PB88-131552</p><p>page_range: 65-74</p><p>primary_author: Schaller, Donald F</p><p>title: Quality of care review: recent experience in Arizona.</p><p>volume: Supp.</p><p>year_period: 1986 Supp.</p>]]></description></item><item><title>The economic costs of illness: a replication and update.</title><pubDate>Mon, 04 Nov 2019 02:27:48 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191933</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191933</guid><description><![CDATA[<p>abstract: The economic burden resulting from illness, disability, and premature death is of major importance in the allocation of health care resources and in the evaluation of health research and programs. This article updates the 1963 and 1972 studies of the costs of illness. In 1980, the estimated total economic costs of illness were $455 billion: $211 billion for direct costs, $68 billion for morbidity, and $176 billion for mortality. Diseases of the circulatory system and injuries and poisonings were the most costly, with variations in the diagnostic distributions among the three types of costs and by age and sex.</p><p>authors: Hodgson, Thomas A; Kopstein, Andrea N</p><p>issue_mesh: Costs and Cost Analysis : Adolescence : Adult : Age Factors : Aged : Disease/economics : Female : Human : Male : Middle Age : Sex Factors : Socioeconomic Factors : Statistics : Support, Non-U.S. Gov't : United States</p><p>issue_number: 1</p><p>ntis_number: PB86-156759</p><p>page_range: 61-80</p><p>primary_author: Rice, Dorothy P</p><p>title: The economic costs of illness: a replication and update.</p><p>volume: 7</p><p>year_period: 1985 Fall</p>]]></description></item><item><title>Mental Health Issues</title><pubDate>Mon, 04 Nov 2019 02:27:48 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191788</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191788</guid><description><![CDATA[<p>page_range: 1-4</p><p>primary_author: Clark, Peggy</p><p>title: Mental Health Issues</p><p>volume: 26</p><p>year_period: 2004 Fall</p>]]></description></item><item><title>A profile of functionally impaired elderly persons living in the community.</title><pubDate>Mon, 04 Nov 2019 02:27:48 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191955</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191955</guid><description><![CDATA[<p>abstract: The Health Care Financing Administration, in cooperation with other agencies of the Department of Health and Human Services, conducted surveys in 1982 and 1984 designed to develop a better understanding of the number and circumstances of functionally impaired elderly persons living in the community. This report is based on data from the 1982 Long-Term Care Survey. There were approximately 5 million functionally impaired elderly persons living in the community in 1982. The data show that functionally impaired persons in the community are older, are more often female, have lower incomes, and have a larger proportion of black people than the general elderly population. The data also provide baseline information on what functional impairments are prevalent among them, what means they use to cope with the limitations, and from whom they receive help. The baselines data gathered in 1982 will be supplemented by longitudinal data gathered in the 1984 Long-Term Care Survey.</p><p>authors: N/A</p><p>issue_mesh: Activities of Daily Living : Aged : Health Surveys : Medicare : Age Factors : Demography : Female : Human : Long-Term Care/utilization : Male : Sex Factors : Statistics : United States : United States Health Care Financing Administration</p><p>issue_number: 4</p><p>ntis_number: PB86-241262</p><p>page_range: 33-49</p><p>primary_author: Macken, Candace L</p><p>title: A profile of functionally impaired elderly persons living in the community.</p><p>volume: 7</p><p>year_period: 1986 Summer</p>]]></description></item><item><title>Evaluating and improving the measurement of hospital case mix.</title><pubDate>Mon, 04 Nov 2019 02:27:48 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191876</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191876</guid><description><![CDATA[<p>ntis_number: PB85-155083</p><p>page_range: 1-12</p><p>primary_author: Jencks, Stephen F</p><p>title: Evaluating and improving the measurement of hospital case mix.</p><p>volume: Supp.</p><p>year_period: 1984 Supp.</p>]]></description></item><item><title>Physician medical malpractice.</title><pubDate>Mon, 04 Nov 2019 02:27:48 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191936</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191936</guid><description><![CDATA[<p>abstract: Malpractice insurance premiums for physicians have increased at an average rate of over 30 percent per year. This rate is significantly higher than health care cost inflation and the increase in physician costs. Trends indicate that malpractice related costs, both liability insurance and defensive medicine costs, will continue to increase for the near future. Pressures to limit physician costs under Medicare raise a concern about how malpractice costs can be controlled. This paper presents an overview of the problem, reviews options that are available to policymakers, and discusses State and legislative efforts to address the issue.</p><p>authors: N/A</p><p>issue_mesh: Physicians : Insurance, Liability/legislation &#x26; jurisprudence : Legislation, Medical : Malpractice/economics : Medicare/economics : United States</p><p>issue_number: 1</p><p>ntis_number: PB86-156759</p><p>page_range: 111-116</p><p>primary_author: LeMasurier, Jean</p><p>title: Physician medical malpractice.</p><p>volume: 7</p><p>year_period: 1985 Fall</p>]]></description></item><item><title>Medicare case-mix index increase.</title><pubDate>Mon, 04 Nov 2019 02:27:48 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191956</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191956</guid><description><![CDATA[<p>abstract: Medicare paid hospitals a higher amount per admission in 1984 than had been planned because the case-mix index (CMI), which reflects the proportion of patients in high-weighted DRG's versus low-weighted ones, increased more than had been projected. This study estimated the degree to which the increase in the CMI from 1981 reflected medical practice changes, the aging of the Medicare inpatient population, changes in coding practices of physicians and hospitals, and changes in the way that the Health Care Financing Administration collects the data on case-mix. All of the above, except for aging, contributed to the increase in the CMI.</p><p>authors: Carter, Grace M</p><p>issue_mesh: Abstracting and Indexing : Commission on Professional and Hospital Activities : Diagnosis-Related Groups/economics : Hospitals, Community/economics : Medicare/economics : Regression Analysis : Support, U.S. Gov't, Non-P.H.S. : United States : United States Health Care Financing Administration</p><p>issue_number: 4</p><p>ntis_number: PB86-241262</p><p>page_range: 51-65</p><p>primary_author: Ginsburg, Paul B</p><p>title: Medicare case-mix index increase.</p><p>volume: 7</p><p>year_period: 1986 Summer</p>]]></description></item><item><title>Should children's hospitals have special consideration in reimbursement policy?</title><pubDate>Mon, 04 Nov 2019 02:27:48 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191981</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191981</guid><description><![CDATA[<p>abstract: Children's hospitals were excluded indefinitely from the prospective payment system until a methodology for their reimbursement could be developed. Special consideration in reimbursement policy could be made for children's hospitals if their patients were generally more resource intensive than the pediatric patients of other hospitals. The resource intensity of patients in children's hospitals was compared with pediatric patients in other hospital groups. The results indicate that the patient population of children's hospitals is similar to the pediatric patient population of university hospitals and considerably different from the pediatric patient populations of the urban and rural hospitals.</p><p>authors: Dreachslin, Janice L; Fisher, James</p><p>issue_mesh: Reimbursement Mechanisms : Adolescence : Child : Child, Preschool : Comparative Study : Data Collection : Diagnosis-Related Groups/economics : Health Services Research : Hospitals, Pediatric/utilization : Hospitals, Special/utilization : Hospitals/utilization : Human : Infant : Infant, Newborn : Medicare/utilization : Statistics : Support, Non-U.S. Gov't : United States</p><p>issue_number: 1</p><p>ntis_number: PB88-131545</p><p>page_range: 55-63</p><p>primary_author: Long, Michael J</p><p>title: Should children's hospitals have special consideration in reimbursement policy?</p><p>volume: 8</p><p>year_period: 1986 Fall</p>]]></description></item><item><title>The economics of information exchange: Medicaid in Wisconsin.</title><pubDate>Mon, 04 Nov 2019 02:27:48 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191982</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191982</guid><description><![CDATA[<p>abstract: In Medicaid, as in all third-party insurance, there are significant costs for information exchange between providers of services and the State (or other insurer), which reimburses those providers. On the basis of a study of Medicaid in Wisconsin, this article indicates that appreciable costs are incurred owing to deficiencies in information exchange between these parties. It is proposed that the costs of automated interventions, which could improve information exchange, be compared with the existing costs of the present system of information exchange.</p><p>authors: Helminiak, Thomas; Smolensky, Eugene</p><p>issue_mesh: Costs and Cost Analysis : Hospitals : Insurance Claim Reporting/economics : Management Information Systems/economics : Medicaid/organization &#x26; administration : Reimbursement Mechanisms : Wisconsin</p><p>issue_number: 1</p><p>ntis_number: PB88-131545</p><p>page_range: 65-78</p><p>primary_author: Andreano, Ralph</p><p>title: The economics of information exchange: Medicaid in Wisconsin.</p><p>volume: 8</p><p>year_period: 1986 Fall</p>]]></description></item><item><title>Impact of the Medicare prospective payment system for hospitals.</title><pubDate>Mon, 04 Nov 2019 02:27:48 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191951</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191951</guid><description><![CDATA[<p>abstract: This article describes some of the available evidence on the impact of the Medicare prospective payment system (PPS) for hospitals during its first year, on hospitals, other payers for inpatient hospital services, other providers of health care, and Medicare beneficiaries. In addition, because the impetus for the enactment of the new system stemmed from concern over the financial status of the Medicare program, the first-year impact of PPS on Medicare program expenditures is also described.</p><p>authors: Dobson, Allen</p><p>issue_mesh: Medicare : Data Collection : Economics, Hospital/trends : Health Expenditures/trends : Hospitalization/trends : Prospective Payment System/economics : Reimbursement Mechanisms/economics : United States</p><p>issue_number: 3</p><p>ntis_number: PB86-217973</p><p>page_range: 97-114</p><p>primary_author: Guterman, Stuart</p><p>title: Impact of the Medicare prospective payment system for hospitals.</p><p>volume: 7</p><p>year_period: 1986 Spring</p>]]></description></item><item><title>Consumer information needs in a competitive health care environment.</title><pubDate>Mon, 04 Nov 2019 02:27:48 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191975</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191975</guid><description><![CDATA[<p>ntis_number: PB88-131552</p><p>page_range: 99-104</p><p>primary_author: Varner, Theresa</p><p>title: Consumer information needs in a competitive health care environment.</p><p>volume: Supp.</p><p>year_period: 1986 Supp.</p>]]></description></item><item><title>Prospective payment for Medicare skilled nursing facilities: background and issues.</title><pubDate>Mon, 04 Nov 2019 02:27:48 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191983</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191983</guid><description><![CDATA[<p>abstract: Strong interest by Congress in a Medicare prospective payment system for skilled nursing facilities (SNF's) resulted in a major study by the Health Care Financing Administration on the Medicare SNF benefit. This article highlights findings from that study, which addressed the following: the Medicare SNF benefit, utilization and expenditures, the Medicare SNF industry, problems with the current Medicare SNF reimbursement system, efforts to develop a Medicare SNF case-mix measure, and case-mix differences between hospital-based and freestanding SNF's. In addition, we discuss the implications of the study findings for the design of a Medicare SNF prospective payment system (PPS).</p><p>authors: Doty, Pamela; Schieber, George J; Wiener, Joshua</p><p>issue_mesh: Medicare : Prospective Payment System : Costs and Cost Analysis : Data Collection : Skilled Nursing Facilities/economics : Statistics : United States</p><p>issue_number: 1</p><p>ntis_number: PB88-131545</p><p>page_range: 79-85</p><p>primary_author: Liu, Korbin</p><p>title: Prospective payment for Medicare skilled nursing facilities: background and issues.</p><p>volume: 8</p><p>year_period: 1986 Fall</p>]]></description></item><item><title>Twenty years of Medicare and Medicaid: covered populations, use of benefits, and program expenditures.</title><pubDate>Mon, 04 Nov 2019 02:27:48 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191916</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191916</guid><description><![CDATA[<p>ntis_number: PB86-156551</p><p>page_range: 13-59</p><p>primary_author: Gornick, Marian</p><p>title: Twenty years of Medicare and Medicaid: covered populations, use of benefits, and program expenditures.</p><p>volume: Supp.</p><p>year_period: 1985 Supp.</p>]]></description></item><item><title>Drug Policy Down Under: Australia's Pharmaceutical Benefits Scheme</title><pubDate>Mon, 04 Nov 2019 02:27:48 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191776</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191776</guid><description><![CDATA[<p>page_range: 55-67</p><p>primary_author: Duckett, Stephen</p><p>title: Drug Policy Down Under: Australia's Pharmaceutical Benefits Scheme</p><p>volume: 25</p><p>year_period: 2004 Spring</p>]]></description></item><item><title>Outcomes of surgery in the Medicare aged population: rehospitalization after surgery.</title><pubDate>Mon, 04 Nov 2019 02:27:48 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191978</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191978</guid><description><![CDATA[<p>abstract: Using 1979 and 1980 data, rehospitalization rates following eight common surgical procedures are examined for aged Medicare beneficiaries. Rehospitalization rates within 30 days after discharge from the surgical stay varied considerably among procedures and were higher for older beneficiaries. Patients residing in the Northeast had the lowest rates of rehospitalization, although their rehospitalizations tended to be lengthier than those elsewhere. Rehospitalization rates were also tracked for 9 months following discharge from the surgical stay. For all procedures, rehospitalization rates decreased during the 9 months after discharge, but they remained above the prevailing hospitalization rate for the Medicare aged population for the entire 9 months. Principal diagnoses associated with rehospitalizations within 30 days were often related to the body system on which surgery was initially performed, suggesting that many rehospitalizations are for continuing problems related to the initial condition that necessitated surgery. Rehospitalization rates presented in this article will serve as baseline data for monitoring trends under Medicare's prospective payment system for hospitals.</p><p>authors: Lubitz, James</p><p>issue_mesh: Outcome and Process Assessment (Health Care) : Surgical Procedures, Operative : Aged : Data Collection : Female : Human : Male : Medicare/utilization : Patient Readmission/trends : Statistics : Time Factors : United States</p><p>issue_number: 1</p><p>ntis_number: PB88-131545</p><p>page_range: 23-34</p><p>primary_author: Riley, Gerald F</p><p>title: Outcomes of surgery in the Medicare aged population: rehospitalization after surgery.</p><p>volume: 8</p><p>year_period: 1986 Fall</p>]]></description></item><item><title>Rate adjusters for Medicare under capitation.</title><pubDate>Mon, 04 Nov 2019 02:27:46 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191966</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191966</guid><description><![CDATA[<p>ntis_number: PB88-131552</p><p>page_range: 45-55</p><p>primary_author: Newhouse, Joseph P</p><p>title: Rate adjusters for Medicare under capitation.</p><p>volume: Supp.</p><p>year_period: 1986 Supp.</p>]]></description></item><item><title>Hospital payroll costs, productivity, and employment under prospective reimbursement.</title><pubDate>Mon, 04 Nov 2019 02:27:46 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191828</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191828</guid><description><![CDATA[<p>abstract: This paper reports preliminary findings from the National Hospital Rate-Setting Study regarding the effects of State prospective reimbursement (PR) programs on measures of payroll costs and employment in hospitals. PR effects were estimated through reduced-form equations, using American Hospital Association Annual Survey data on over 2,700 hospitals from 1969 through 1978. These tests suggest that hospitals responded to PR by lowering payroll expenditures. PR also seems to have been associated with reductions in full-time equivalent staff per adjusted inpatient day. However, tests did not confirm the hypothesis that hospitals reduce payroll per full-time equivalent staff as a result of PR.</p><p>authors: Sullivan, Daniel</p><p>issue_mesh: Efficiency : Employment : Prospective Payment System : Reimbursement Mechanisms : Salaries and Fringe Benefits : Cost Control : Models, Theoretical : Personnel Administration, Hospital/economics : Personnel Staffing and Scheduling : Support, U.S. Gov't, P.H.S. : United States</p><p>issue_number: 2</p><p>ntis_number: PB83-149815</p><p>page_range: 89-100</p><p>primary_author: Kidder, David</p><p>title: Hospital payroll costs, productivity, and employment under prospective reimbursement.</p><p>volume: 4</p><p>year_period: 1982 Dec</p>]]></description></item><item><title>Cost and case-mix differences between hospital-based and freestanding nursing homes.</title><pubDate>Mon, 04 Nov 2019 02:27:46 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191949</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191949</guid><description><![CDATA[<p>abstract: Cost differences between freestanding and hospital-based skilled nursing facilities (SNF's) are identified and examined in this article. Although hospital-based and freestanding SNF's have significant differences in terms of location, admissions per bed, percent of Medicare days, occupancy rates, staffing, provisions of rehabilitative services, and patient characteristics, these are insufficient to fully explain cost differences. Less than one-half of the existing cost differences can be explained after controlling for case mix, staffing, and other cost-contributing factors. A reimbursement system that differentiates solely by provider type without relating rates to patient characteristics may overcompensate some providers and undercompensate others.</p><p>authors: Holahan, John</p><p>issue_mesh: Costs and Cost Analysis : Diagnosis-Related Groups : Medicare : Comparative Study : Ownership/economics : Regression Analysis : Skilled Nursing Facilities/economics : Support, U.S. Gov't, Non-P.H.S. : United States</p><p>issue_number: 3</p><p>ntis_number: PB86-217973</p><p>page_range: 75-84</p><p>primary_author: Sulvetta, Margaret B</p><p>title: Cost and case-mix differences between hospital-based and freestanding nursing homes.</p><p>volume: 7</p><p>year_period: 1986 Spring</p>]]></description></item><item><title>Cross-national differences in dialysis rates.</title><pubDate>Mon, 04 Nov 2019 02:27:46 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191835</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191835</guid><description><![CDATA[<p>abstract: The dialysis treatment rate is more than 50 percent higher in the United States than it is in any West European nation. Relman and Rennie's analysis of this difference in rates raised the possibility that the extra care provided in the United States is unnecessary and is partially attributable to the existence of a private market for renal dialysis services. Their analysis ignores the effect of race on treatment needs in the United States. About 50 percent of the difference observed in rates between the American experience and the European maximum can be attributed to differences in the black/white composition of the populations. Most of the remaining difference in rates appears to be due to European policies that prohibit or severely limit access to dialysis by the elderly and those potential patients with significant medical complications.</p><p>authors: Sapolsky, Harvey M; Segal, Mark</p><p>issue_mesh: Health Policy : Adult : Age Factors : Aged : Blacks : Comparative Study : Dialysis/utilization : Europe : Human : Kidney Failure, Chronic/mortality : Male : Middle Age : Regression Analysis : United States</p><p>issue_number: 3</p><p>ntis_number: PB83-175620</p><p>page_range: 91-103</p><p>primary_author: Prottas, Jeffrey</p><p>title: Cross-national differences in dialysis rates.</p><p>volume: 4</p><p>year_period: 1983 Mar</p>]]></description></item><item><title>The Medicare experience with end-stage renal disease: trends in incidence, prevalence, and survival.</title><pubDate>Mon, 04 Nov 2019 02:27:46 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191861</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191861</guid><description><![CDATA[<p>abstract: This article presents a detailed account of the incidence, prevalence, and survival experience of people with end-stage renal disease (ESRD) covered by Medicare. The number of new entrants into the ESRD program has risen since its inception. This increase is greatest for people whose cause of renal failure is primary hypertensive disease or diabetic nephropathy. The program incidence rates for black people is 2.8 times that of white people. Incidence is highest for persons 65 to 69 years of age. Total patient survival is 44 percent 5 years after renal failure onset. Total Medicare enrollment for ESRD quadrupled between the years 1974 and 1981.</p><p>authors: Connerton, Rose E; McMullan, Michael</p><p>issue_mesh: Adolescence : Adult : Aged : Child : Child, Preschool : Data Collection : Dialysis/utilization : Female : Human : Infant : Infant, Newborn : Kidney Failure, Chronic/economics/epidemiology : Male : Medicare/utilization : Middle Age : United States</p><p>issue_number: 3</p><p>ntis_number: PB84-189844</p><p>page_range: 69-88</p><p>primary_author: Eggers, Paul W</p><p>title: The Medicare experience with end-stage renal disease: trends in incidence, prevalence, and survival.</p><p>volume: 5</p><p>year_period: 1984 Spring</p>]]></description></item><item><title>The Medicaid program in Puerto Rico: description, context, and trends.</title><pubDate>Mon, 04 Nov 2019 02:27:46 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191838</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191838</guid><description><![CDATA[<p>abstract: The Medicaid program in Puerto Rico differs from United States Medicaid programs in several important ways. First, it operates within a larger, centrally administered health care delivery system. Approximately half of Puerto Rico's 3.2 million inhabitants are poor and depend upon the public health system for their medical care. Second, recipients are not free to choose their own provider, but are referred to the proper level of care by public health care system professionals. Third, this system has a low average recipient cost. Fourth, Congress has "capped" the Federal financial participation since 1968. Finally, despite the economic constraints and large Medicaid population, health status in Puerto Rico compares favorably with that in the United States. This study describes the organization and operation of Puerto Rico's Medicaid program in terms of basic expenditures and utilization data. The Puerto Rican program is an important example of an alternative health care delivery system for the poor. It is interesting in the contrast it provides to United States Medicaid programs and as a case study of how such a program operates when Federal financing is "capped" over a period of time.</p><p>authors: Muse, Donald N</p><p>issue_mesh: Delivery of Health Care/organization &#x26; administration : Health Services/utilization : Medicaid/organization &#x26; administration : Puerto Rico</p><p>issue_number: 4</p><p>ntis_number: PB83-220657</p><p>page_range: 1-17</p><p>primary_author: Pagan-Berlucchi, Eileen</p><p>title: The Medicaid program in Puerto Rico: description, context, and trends.</p><p>volume: 4</p><p>year_period: 1983 Summer</p>]]></description></item><item><title>Utilization of services in Arizona's capitated Medicaid program for long-term care beneficiaries.</title><pubDate>Mon, 04 Nov 2019 02:27:46 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191525</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191525</guid><description><![CDATA[<p>abstract: The Arizona Long-Term Care System (ALTCS), Arizona's Medicaid program for long-term care (LTC) beneficiaries, capitates contractors to provide a full range of acute and LTC services to financially-eligible beneficiaries determined to be at risk of institutionalization. This article compares the acute care utilization experience of LTC beneficiaries in ALTCS with those in a fee-for-service (FFS) Medicaid program, linking data from both the Medicare and the Medicaid program files. Patterns of use observed in Arizona seem more consistent with a managed care environment than those observed in the FFS comparison. Rates of acute care utilization observed for both the capitated and the FFS program should be of interest to States considering incorporating LTC beneficiaries into their Medicaid managed care program.</p><p>authors: Korb, Jodi</p><p>issue_mesh: Aged : Aged, 80 and over : Arizona : Comparative Study : Data Interpretation, Statistical : Demography : Fee-for-Service Plans/economics/utilization : Female : Health Services Research : Human : Long-Term Care/economics/utilization : Male : Managed Care Programs/economics/utilization : Medicaid/statistics &#x26; numerical data : Medicare : Middle Age : New Mexico : State Health Plans/economics : Support, U.S. Gov't, Non-P.H.S. : United States</p><p>issue_number: 2</p><p>ntis_number: PB99-109639</p><p>page_range: 119-134</p><p>primary_author: McCall, Nelda</p><p>title: Utilization of services in Arizona's capitated Medicaid program for long-term care beneficiaries.</p><p>volume: 19</p><p>year_period: 1997 Winter</p>]]></description></item><item><title>Trends in Medicare reimbursement for end-stage renal disease: 1974-1979.</title><pubDate>Mon, 04 Nov 2019 02:27:46 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191886</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191886</guid><description><![CDATA[<p>abstract: This article presents detailed analyses of the trends in Medicare expenditures for persons with end-stage renal disease. Program expenditures increased at an annual rate of 30.5 percent from 1974 to 1981. Three-fourths of this increase was a result of increases in enrollment. Per capita reimbursements for dialysis patients increased at a 5.2-percent annual rate and per capita reimbursements for transplant patients increased at a 10.5-percent annual rate. In 1979, per capital reimbursements for home dialysis patients were $5,000 less than for in-unit dialysis patients. Patient characteristics such as age, sex, race, and cause of renal failure were, for the most part, unrelated to the costs of dialysis and transplantation.</p><p>authors: N/A</p><p>issue_mesh: Comparative Study : Hemodialysis Units, Hospital/economics : Hemodialysis, Home/economics : Hospital Units/economics : Human : Kidney Failure, Chronic/economics : Kidney Transplantation : Kidney/transplantation : Medicare/trends : United States</p><p>issue_number: 1</p><p>ntis_number: PB85-124188</p><p>page_range: 31-38</p><p>primary_author: Eggers, Paul W</p><p>title: Trends in Medicare reimbursement for end-stage renal disease: 1974-1979.</p><p>volume: 6</p><p>year_period: 1984 Fall</p>]]></description></item><item><title>Impact of the BBA on post-acute utilization</title><pubDate>Mon, 04 Nov 2019 02:27:46 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191579</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191579</guid><description><![CDATA[<p>abstract: In this article, the author summarizes recent changes in Medicare post-acute payment policies, discusses the implications of certain design and implementation issues, and analyzes whether different types of patients are using skilled nursing facilities (SNFs), home health agencies (HHAs), and rehabilitation hospitals and units. If similar populations are treated by these three types of providers, service patterns may be affected by the financial incentives in the new, more restrictive payment policies. The author describes new post-acute care (PAC) payment policies, service patterns prior to the Balanced Budget Act of 1997 (BBA), differences in the populations using these providers, and possible effects of the new payment systems on site-of-care decisions.</p><p>authors: N/A</p><p>issue_mesh: Skilled Nursing Facilities : Aged : Evaluation Studies : Home Care Agencies : Medicare/economics/legislation &#x26; jurisprudence : Multivariate Analysis : Nursing Homes/utilization : Rehabilitation Centers/utilization : Support, non-U.S. Gov't : United States</p><p>issue_number: 4</p><p>ntis_number: PB2000-102444</p><p>page_range: 103-126</p><p>primary_author: Gage, Barbara</p><p>title: Impact of the BBA on post-acute utilization</p><p>volume: 20</p><p>year_period: 1999 Summer</p>]]></description></item><item><title>Copayments and consumer search: increasing competition in Medicare and other insured medical markets.</title><pubDate>Mon, 04 Nov 2019 02:27:46 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191808</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191808</guid><description><![CDATA[<p>abstract: Between 1950 and 1980, the physician fee component of the Consumer Price Index (CPI) rose 488 percent. In contrast, an index of physician fees adjusted for 1) overall inflation, and 2) the declining proportion which is paid out-of-pocket by the patient, declined over the same 30-year period. This last observation, pointing to the erosion of the market, is important for structuring price competition for physician services. For insured patients, out-of-pocket payments arise from deductibles, coinsurance and limits, each of which is briefly discussed in this article. Following a review of Medicare Part B physician reimbursement, the paper shows that limits can be used to strengthen the incentive which insured patients have to search for less expensive medical care.</p><p>authors: N/A</p><p>issue_mesh: Comparative Study : Consumer Participation/economics : Deductibles and Coinsurance/trends : Fees, Medical/trends : Insurance, Physician Services/trends : Medicare/economics : United States</p><p>issue_number: 2</p><p>ntis_number: PB82-188426</p><p>page_range: 65-76</p><p>primary_author: Cantwell, James R</p><p>title: Copayments and consumer search: increasing competition in Medicare and other insured medical markets.</p><p>volume: 3</p><p>year_period: 1981 Dec</p>]]></description></item><item><title>Home care expenses for the disabled elderly.</title><pubDate>Mon, 04 Nov 2019 02:27:46 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191941</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191941</guid><description><![CDATA[<p>abstract: This article presents descriptive statistics from the 1982 Long-Term Care Survey on noninstitutionalized elderly Americans with limitations in activities of daily living (ADL) and instrumental activities of daily living (IADL). The focus of this article is on private expenses for home-based care related to ADL and IADL limitations. We describe the amounts of out-of-pocket payments expended relative to the characteristics of the home-based, disabled elderly population. We also discuss several possible implications of the findings for policymakers and further research.</p><p>authors: Liu, Barbara M; Manton, Kenneth G</p><p>issue_mesh: Disabled Persons : Financing, Personal : Activities of Daily Living : Aged : Home Care Services/economics : Human : Institutionalization : Long-Term Care/economics : Statistics : United States</p><p>issue_number: 2</p><p>ntis_number: PB86-198900</p><p>page_range: 51-58</p><p>primary_author: Liu, Korbin</p><p>title: Home care expenses for the disabled elderly.</p><p>volume: 7</p><p>year_period: 1985 Winter</p>]]></description></item><item><title>Comparison of alternative relative weights for diagnosis-related groups.</title><pubDate>Mon, 04 Nov 2019 02:27:46 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191946</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191946</guid><description><![CDATA[<p>abstract: During this study, we investigated the extent to which diagnosis-related group (DRG) relative weights based exclusively on charge data differ from DRG weights constructed according to the methodology used in deriving the original relative weights for the Medicare prospective payment system (PPS). The PPS operating cost weights were based on a combination of cost and adjusted charge information (Pettengill and Vertrees, 1982). The results of this study reveal only minor differences between the two sets of weights. Interhospital differences in cost-to-charge ratios do not produce large, arbitrary differences between charge-based and operating cost weights. Whether the data are standardized for differences in capital and medical education costs also appears to make little difference.</p><p>authors: Bobula, Joel; Connerton, Rose E</p><p>issue_mesh: Medicare : Comparative Study : Cost Allocation/methods : Costs and Cost Analysis/methods : Diagnosis-Related Groups/economics : Fees and Charges : Prospective Payment System/methods : Rate Setting and Review/methods : Reimbursement Mechanisms/methods : Statistics : United States : United States Health Care Financing Administration</p><p>issue_number: 3</p><p>ntis_number: PB86-217973</p><p>page_range: 37-51</p><p>primary_author: Cotterill, Philip G</p><p>title: Comparison of alternative relative weights for diagnosis-related groups.</p><p>volume: 7</p><p>year_period: 1986 Spring</p>]]></description></item><item><title>Does health status explain higher Medicare costs of Medicaid enrollees?</title><pubDate>Mon, 04 Nov 2019 02:27:46 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191559</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191559</guid><description><![CDATA[<p>abstract: In this article, the authors present findings on differences in Medicare costs between elderly beneficiaries who are dually eligible for Medicare and Medicaid and other Medicare beneficiaries. Data from the Medicare Current Beneficiary Survey (MCBS) were used in the analysis. After controlling for health and functional-status differences, the higher Medicare costs of dual eligible persons, relative to other enrollees, was reduced from 282 percent to 45 percent.</p><p>authors: Aragon, Cynthia; Long, Sharon K</p><p>issue_mesh: Aged : Eligibility Determination/economics : Health Services Needs and Demand/economics : Health Surveys : Human : Medicaid : Medicare : Multivariate Analysis : Support, U.S. Gov't, Non-P.H.S. : United States</p><p>issue_number: 2</p><p>ntis_number: PB2000-102915</p><p>page_range: 39-54</p><p>primary_author: Liu, Korbin</p><p>title: Does health status explain higher Medicare costs of Medicaid enrollees?</p><p>volume: 20</p><p>year_period: 1998 Winter</p>]]></description></item><item><title>The hidden costs of treating severely ill patients: charges and resource consumption in an intensive care unit.</title><pubDate>Mon, 04 Nov 2019 02:27:46 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191848</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191848</guid><description><![CDATA[<p>abstract: A detailed survey of the resources used by two common groups of intensive care unit (ICU) admissions in one medical center hospital found substantial cross-subsidization, with healthier patients admitted for monitoring using significantly less labor resources than sicker patients. Both groups had equal bed charges. This suggests that the resource costs of admitting stable patients to an ICU for monitoring are smaller than their average bed charge. On the other hand, the actual resource costs of treating sicker patients are almost twice their billed ICU charges. ICU care is approximately 3.8 times more expensive than routine hospital care, a higher ratio than previously estimated. These results should be considered when estimating the national cost of treating severely ill patients and when proposing changes in hospital reimbursement policies, especially with regard to ICU patients.</p><p>authors: Knaus, William A; Wineland, Thomas D</p><p>issue_mesh: Ancillary Services, Hospital/economics : Diagnosis-Related Groups : District of Columbia : Fees and Charges : Hospital Bed Capacity, 500 and over : Intensive Care Units/economics : Support, U.S. Gov't, Non-P.H.S. : Support, U.S. Gov't, P.H.S.</p><p>issue_number: 1</p><p>ntis_number: PB84-125715</p><p>page_range: 81-86</p><p>primary_author: Wagner, Douglas P</p><p>title: The hidden costs of treating severely ill patients: charges and resource consumption in an intensive care unit.</p><p>volume: 5</p><p>year_period: 1983 Fall</p>]]></description></item><item><title>Outcomes of surgery among the Medicare aged: surgical volume and mortality.</title><pubDate>Mon, 04 Nov 2019 02:27:46 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191931</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191931</guid><description><![CDATA[<p>abstract: We examined the relation between surgical volume and mortality, within 60 days of surgery, for eight procedures on aged Medicare beneficiaries. Logistic regression revealed that high surgical volume was significantly associated with lower mortality for resection of the intestine, coronary artery bypass, transurethral resection of the prostate (TURP), and hip arthroplasty (excluding total hip replacement). For cholecystectomy, total hip replacement, inguinal hernia repair, and femur fracture reduction, no relationship was found between surgical volume and postsurgical mortality. The analyses were repeated using inhospital deaths as the dependent variable, and the results indicated a considerably stronger association between volume and mortality.</p><p>authors: Lubitz, James</p><p>issue_mesh: Hospitals : Medicare : Aged : Female : Human : Male : Postoperative Complications/mortality : Statistics : Surgical Procedures, Operative/utilization : United States</p><p>issue_number: 1</p><p>ntis_number: PB86-156759</p><p>page_range: 37-47</p><p>primary_author: Riley, Gerald F</p><p>title: Outcomes of surgery among the Medicare aged: surgical volume and mortality.</p><p>volume: 7</p><p>year_period: 1985 Fall</p>]]></description></item><item><title>Medicare Drugs</title><pubDate>Mon, 04 Nov 2019 02:27:46 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191766</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191766</guid><description><![CDATA[<p>page_range: 1-5</p><p>primary_author: Poisal, John</p><p>title: Medicare Drugs</p><p>volume: 25</p><p>year_period: 2003 Winter</p>]]></description></item><item><title>Trends in Tennessee Medicaid acute care: use and expenditures, 1974-1978.</title><pubDate>Mon, 04 Nov 2019 02:27:46 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191816</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191816</guid><description><![CDATA[<p>abstract: Because person-level data are not currently available at the Federal level, many questions regarding the use and expenditures of Medicaid services remain unanswered. This article demonstrates the capability of State Medicaid Management Information Systems (MMIS) to provide data that can address a variety of Medicaid program issues at both the State and Federal levels. Using data from the Tennessee Medicaid files, we analyze MMIS data to demonstrate the utility of person level statistics and to indicate methodologies useful for future analytic efforts, particularly in constructing utilization rates for policy and program management activities. While total Tennessee Medicaid enrollment is declining, the number of disabled enrollees and the proportion of aged enrollees are increasing. Tennessee Medicaid average covered lengths of stay exhibit a downward trend, but covered days of care rates are increasing due to higher admission rates. Medicaid payments per enrollee increased drastically, primarily due to increases in average payments per day and, to a lesser extent, increased utilization. Medicaid utilization and expenditures are highly skewed toward aged and disabled enrollees and toward those with less than six consecutive quarters of enrollment. Similarly, whites exhibit a disproportionate use of inpatient services. Analyses of diagnostic case-mix indicate stable patterns of both AFDC and disabled enrollees over time. Differences in case-mix and length of stay between the two eligibility groups are consistent with the respective characteristics of these populations.</p><p>authors: Baugh, David K; Dobson, Allen; Schurman, Rachel A</p><p>issue_mesh: Adolescence : Adult : Age Factors : Aged : Comparative Study : Diagnosis-Related Groups : Eligibility Determination/trends : Female : Human : Medicaid/utilization : Middle Age : Models, Theoretical : Sex Factors : Statistics : Tennessee</p><p>issue_number: 4</p><p>ntis_number: PB82-219213</p><p>page_range: 15-43</p><p>primary_author: Cromwell, Jerry L</p><p>title: Trends in Tennessee Medicaid acute care: use and expenditures, 1974-1978.</p><p>volume: 3</p><p>year_period: 1982 Jun</p>]]></description></item><item><title>Regional hospital input price indexes.</title><pubDate>Mon, 04 Nov 2019 02:27:46 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191806</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191806</guid><description><![CDATA[<p>abstract: This paper describes the development of regional hospital input price indexes that is consistent with the general methodology used for the National Hospital Input Price Index. The feasibility of developing regional indexes was investigated because individuals inquired whether different regions experienced different rates of increase in hospital input prices. The regional indexes incorporate variations in cost-share weights (the amount an expense category contributes to total spending) associated with hospital type and location, and variations in the rate of input price increases for various regions. We found that between 1972 and 1979 none of the regional price indexes increased at average annual rates significantly different from the national rate. For the more recent period 1977 through 1979, the increase in one Census Region was significantly below the national rate. Further analyses indicated that variations in cost-share weights for various types of hospitals produced no substantial variations in the regional price indexes relative to the national index. We consider these findings preliminary because of limitations in the availability of current, relevant, and reliable data, especially for local area wage rate increases.</p><p>authors: Anderson, Gerald F; Schendler, Carol E</p><p>issue_mesh: Abstracting and Indexing : Analysis of Variance : Comparative Study : Costs and Cost Analysis/trends : Economics, Hospital/trends : Fees and Charges/trends : Inflation, Economic/trends : Salaries and Fringe Benefits/trends : United States</p><p>issue_number: 2</p><p>ntis_number: PB82-188426</p><p>page_range: 25-48</p><p>primary_author: Freeland, Mark S</p><p>title: Regional hospital input price indexes.</p><p>volume: 3</p><p>year_period: 1981 Dec</p>]]></description></item><item><title>Capitation and the Medicare program: history, issues, and evidence.</title><pubDate>Mon, 04 Nov 2019 02:27:46 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191962</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191962</guid><description><![CDATA[<p>ntis_number: PB88-131552</p><p>page_range: 9-20</p><p>primary_author: Langwell, Kathryn M</p><p>title: Capitation and the Medicare program: history, issues, and evidence.</p><p>volume: Supp.</p><p>year_period: 1986 Supp.</p>]]></description></item><item><title>Measuring and Improving Health Outcomes in Medicare: The Medicare HOS Program</title><pubDate>Mon, 04 Nov 2019 02:27:46 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191778</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191778</guid><description><![CDATA[<p>page_range: 1-3</p><p>primary_author: Haffer, Samuel</p><p>title: Measuring and Improving Health Outcomes in Medicare: The Medicare HOS Program</p><p>volume: 25</p><p>year_period: 2004 Summer</p>]]></description></item><item><title>Summary of a conference on national health expenditures accounting.</title><pubDate>Mon, 04 Nov 2019 02:27:46 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191959</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191959</guid><description><![CDATA[<p>authors: Newhouse, Joseph P</p><p>issue_mesh: Health Expenditures : Accounting/standards : Data Collection : Statistics : United States : United States Health Care Financing Administration</p><p>issue_number: 4</p><p>ntis_number: PB86-241262</p><p>page_range: 87-96</p><p>primary_author: Lindsey, Phoebe A</p><p>title: Summary of a conference on national health expenditures accounting.</p><p>volume: 7</p><p>year_period: 1986 Summer</p>]]></description></item><item><title>Individual health accounts: an alternative health care financing approach.</title><pubDate>Mon, 04 Nov 2019 02:27:45 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191801</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191801</guid><description><![CDATA[<p>abstract: After examining the major determinants of inefficiency in health care markets and several recent proposals to correct these problems, this paper introduces a market-oriented alternative which could be highly efficient while meeting all the established goals of a national health plan. To achieve these objectives, traditional forms of insurance would be replaced by a system with the following characteristics: (1) instead of buying insurance, individuals and their employers would be required to contribute into individual health accounts from which each family would pay for medical care; (2) Once accumulations attain a designated level, any excess accumulations are distributed to the individual; and (3) A national health fund is established to support those without regular accumulations or those whose accounts have been depleted. This paper develops these principles to show how everyone would have access to care as well as the financial security normally associated with comprehensive insurance. But, by inducing many patients to behave as if they were paying for the full cost of care through reductions in potential earnings from their accounts, the paper explains how significant savings in total spending could also be achieved.</p><p>authors: N/A</p><p>issue_mesh: Consumer Participation : Economic Competition : Economics : Insurance, Health : United States</p><p>issue_number: 1</p><p>ntis_number: PB82-130170</p><p>page_range: 117-125</p><p>primary_author: Stano, Miron</p><p>title: Individual health accounts: an alternative health care financing approach.</p><p>volume: 3</p><p>year_period: 1981 Sep</p>]]></description></item><item><title>The effects of hospital rate-setting programs on volumes of hospital services: a preliminary analysis.</title><pubDate>Mon, 04 Nov 2019 02:27:45 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191826</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191826</guid><description><![CDATA[<p>abstract: This article describes a preliminary study of the effects of State rate-setting programs on volumes of hospital services, specifically admission rates, occupancy levels, and average lengths of stay. A volume response to rate-setting may be anticipated as a result of program effects on hospital costs or charges as well as on hospitals' behavioral incentives. We analyzed data for samples of hospitals and counties in States with and without rate-setting programs for the 9-year period 1969 to 1978. The results suggested that rate regulation has brought about, in some States, an increase in hospital occupancy by increasing patients' lengths of stay. Few programs have had a measurable effect on the admission rate. Programs that regulate per diem rates seem to produce more consistent and predictable volume effects than those controlling charges. The findings were generally consistent with prior hypotheses and partially account for earlier findings regarding the effects of rate-setting programs on hospital costs.</p><p>authors: Piro, Paula A</p><p>issue_mesh: Bed Occupancy : Hospitals/utilization : Length of Stay : Patient Admission : Rate Setting and Review/methods : Regression Analysis : Reimbursement, Incentive : Support, U.S. Gov't, P.H.S. : United States</p><p>issue_number: 2</p><p>ntis_number: PB83-149815</p><p>page_range: 47-66</p><p>primary_author: Worthington, Nancy L</p><p>title: The effects of hospital rate-setting programs on volumes of hospital services: a preliminary analysis.</p><p>volume: 4</p><p>year_period: 1982 Dec</p>]]></description></item><item><title>An analysis of hospital costs by cost center, 1971 through 1978.</title><pubDate>Mon, 04 Nov 2019 02:27:45 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191821</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191821</guid><description><![CDATA[<p>abstract: Hospital cost analyses generally have not used costs broken down by hospital department or function due to the unavailability of appropriate data. The Medicare Cost Reports display direct cost by cost center, and the Health Care Financing Administration (HCFA) funded a project to abstract, edit, and categorize these data from a sample of 457 hospitals into meaningful groups. The author used the resulting data base to analyze trends in hospital costs, with cross tabulations by a hospital's teaching status, type of control, and bed size class, from 1971 through 1978. The author also used this data base to preliminarily assess whether introduction of the Medicare Section 223 reimbursement limits altered cost center growth trends. The study found that the largest cost increases occurred among Ancillary Services. It also found slightly higher than average increases in Inpatient Services (concentrated in Special Care Units), and General Services increased at a below average rate. Outpatient Service costs escalated rapidly in absolute terms but rose much more slowly in per unit terms. The fastest growing cost quantity in the study was Other Ancillary Services, a miscellaneous group encompassing many of the new advanced technology services, which increased at a rate of 24 percent per year between 1973 and 1978. The study found costs per unit of output to be positively associated and bed size across all cost center categories, including General Services, where some evidence of economics of scale might have been expected. The study found no evidence that the Section 223 limits affected cost growth longitudinally, but an understanding of the impact of these limits will require considerably more study.</p><p>authors: N/A</p><p>issue_mesh: Costs and Cost Analysis/trends : Data Collection : Direct Service Costs/trends : Hospital Departments/economics : Hospital Units/economics : Medicare : Statistics : United States</p><p>issue_number: 1</p><p>ntis_number: PB83-104414</p><p>page_range: 37-53</p><p>primary_author: Ashby Jr, John L</p><p>title: An analysis of hospital costs by cost center, 1971 through 1978.</p><p>volume: 4</p><p>year_period: 1982 Sep</p>]]></description></item><item><title>Six months of Medicaid data: a summary from the National Medical Care Utilization and Expenditure Survey.</title><pubDate>Mon, 04 Nov 2019 02:27:45 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191837</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191837</guid><description><![CDATA[<p>abstract: This is a summary of the first report in a series of three comprehensive Medicaid program reports based on National Medical Care Utilization and Expenditure Survey data. Preliminary analyses are presented based on data from the first half of 1980 which include the personal characteristics and medical care utilization patterns of noninstitutional Medicaid enrollees and the health insurance coverage of the U.S. noninstitutionalized population. More comprehensive analyses employing full calendar year 1980 data will be available in subsequent reports. The information provided in this summary is useful in appraising the impact of eligibility, benefit package, and reimbursement policy on Medicaid enrollee health care utilization at both the Federal and the State Medicaid level.</p><p>authors: Corder, Larry; Scharff, Jack</p><p>issue_mesh: Comparative Study : Data Collection/methods : Health Services/utilization : Medicaid/utilization : Poverty : United States : United States Dept. of Health and Human Services</p><p>issue_number: 3</p><p>ntis_number: PB83-175620</p><p>page_range: 115-121</p><p>primary_author: Dobson, Allen</p><p>title: Six months of Medicaid data: a summary from the National Medical Care Utilization and Expenditure Survey.</p><p>volume: 4</p><p>year_period: 1983 Mar</p>]]></description></item><item><title>The potential use of Health Care Financing Administration data sets for health care services research.</title><pubDate>Mon, 04 Nov 2019 02:27:45 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191850</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191850</guid><description><![CDATA[<p>abstract: Administrative Record Systems may be an overlooked source of data for health services researchers. Through its administration of the Medicare and Medicaid Programs, the Health Care Financing Administration (HCFA) routinely receives data on items such as its beneficiary population, providers certified to deliver care to its beneficiary population, providers certified to deliver care to the beneficiaries, the use of services and reimbursements to providers. the most important data bases that are useful for research, their relative strengths and weaknesses and the extent to which they are available to outside users.</p><p>authors: Dobson, Allen; Walton, Carol</p><p>issue_mesh: United States Dept. of Health and Human Services : United States Health Care Financing Administration : Data Collection : Health Services Research/methods : Information Systems/utilization : Medicare : United States</p><p>issue_number: 1</p><p>ntis_number: PB84-125715</p><p>page_range: 93-98</p><p>primary_author: Lave, Judith R</p><p>title: The potential use of Health Care Financing Administration data sets for health care services research.</p><p>volume: 5</p><p>year_period: 1983 Fall</p>]]></description></item><item><title>Medicaid fees and the Medicare fee schedule: an update.</title><pubDate>Mon, 04 Nov 2019 02:27:45 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191397</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191397</guid><description><![CDATA[<p>abstract: This study analyzes changes in Medicaid physician fees from 1990 to 1993. Data were collected on maximum allowable Medicaid fees in 1993 and compared with similar 1990 Medicaid data as well as the fully phased-in Medicare Fee Schedule (MFS). The results suggest that, on average, Medicaid fees have grown roughly 14 percent, but considerable variation continues to exist in how well Medicaid programs pay across types of services, States, and census divisions. Medicaid fees remain considerably lower (27 percent for the average Medicaid enrollee) than fees under a fully phased-in MFS. Medicaid fees for primary-care services were, on average, 32 percent lower.</p><p>authors: N/A</p><p>issue_mesh: Fee Schedules/statistics &#x26; numerical data/trends : Health Services/classification/economics/statistics &#x26; numerical data : Medicaid/economics/statistics &#x26; numerical data : Medicare Part B/economics/statistics &#x26; numerical data : Primary Health Care/classification/economics/statistics &#x26; numerical data : Support, U.S. Gov't, Non-P.H.S. : United States</p><p>issue_number: 1</p><p>ntis_number: PB96-139548</p><p>page_range: 167-181</p><p>primary_author: Norton, Stephen A</p><p>title: Medicaid fees and the Medicare fee schedule: an update.</p><p>volume: 17</p><p>year_period: 1995 Fall</p>]]></description></item><item><title>Medicaid Behavioral Health Care Plan Satisfaction and Children's Service Utilization</title><pubDate>Mon, 04 Nov 2019 02:27:45 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191791</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191791</guid><description><![CDATA[<p>page_range: 43-55</p><p>primary_author: Cook, Judith</p><p>title: Medicaid Behavioral Health Care Plan Satisfaction and Children's Service Utilization</p><p>volume: 26</p><p>year_period: 2004 Fall</p>]]></description></item><item><title>Evaluation of the maximum allowable cost program.</title><pubDate>Mon, 04 Nov 2019 02:27:45 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191833</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191833</guid><description><![CDATA[<p>abstract: This article summarizes an evaluation of the Maximum Allowable Cost (MAC)-Estimated Acquisition Cost (EAC) program, the Federal Government's cost-containment program for prescription drugs. The MAC-EAC regulations which became effective on August 26, 1976, have four major components: (1) Maximum Allowable Cost reimbursement limits for selected multisource or generically available drugs; (2) Estimated Acquisition Cost reimbursement limits for all drugs; (3) "usual and customary" reimbursement limits for all drugs; and (4) a directive that professional fee studies be performed by each State. The study examines the benefits and costs of the MAC reimbursement limits for 15 dosage forms of five multisource drugs and EAC reimbursement limits for all drugs for five selected States as of 1979.</p><p>authors: Dobson, Allen; Hardy Jr, Ralph; Hefner, Dennis</p><p>issue_mesh: Rate Setting and Review : Therapeutic Equivalency : Cost-Benefit Analysis/methods : Drug Industry/economics : Evaluation Studies : Insurance, Pharmaceutical Services/legislation &#x26; jurisprudence : Medicaid/economics : Minnesota : Prescriptions, Drug/economics : Support, U.S. Gov't, Non-P.H.S. : United States</p><p>issue_number: 3</p><p>ntis_number: PB83-175620</p><p>page_range: 71-82</p><p>primary_author: Lee, A James</p><p>title: Evaluation of the maximum allowable cost program.</p><p>volume: 4</p><p>year_period: 1983 Mar</p>]]></description></item><item><title>National health expenditure growth in the 1980's: an aging population, new technologies, and increasing competition.</title><pubDate>Mon, 04 Nov 2019 02:27:45 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191831</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191831</guid><description><![CDATA[<p>abstract: Health care spending in the United States more than tripled between 1971 and 1981, increasing from $83 billion to $287 billion. This growth in health sector spending substantially outpaced overall growth in the economy, averaging 13.2 percent per year compared to 10.5 percent for the gross national product (GNP). By 1981, one out of every ten dollars of GNP was spent on health care, compared to one out of every thirteen dollars of GNP in 1971. If current trends continue and if present health care financing arrangements remain basically unchanged, national health expenditures are projected to reach approximately $756 billion in 1990 and consume roughly 12 percent of GNP. The focal issue in health care today is cost and cost increases. The outlook for the 1980's is for continued rapid growth but at a diminished rate. The primary force behind this moderating growth is projected lower inflation. However, real growth rates are also expected to moderate slightly. The chief factors influencing the growth of health expenditures in the eighties are expected to be aging of the population, new medical technologies, increasing competition, restrained public funding, growth in real income, increased health manpower, and a deceleration in economy-wide inflation. Managers, policy makers and providers in the health sector, as in all sectors, must include in today's decisions probable future trends. Inflation, economic shocks, and unanticipated outcomes of policies over the last decade have intensified the need for periodic assessments of individual industries and their relationship to the macro economy. This article provides such an assessment for the health care industry. Baseline current-law projections of national health expenditures are made to 1990.</p><p>authors: Schendler, Carol E</p><p>issue_mesh: Comparative Study : Costs and Cost Analysis/trends : Economic Competition/trends : Financing, Government/trends : Forecasting : Health Expenditures/trends : Health Services/economics : Inflation, Economic/trends : Statistics : United States</p><p>issue_number: 3</p><p>ntis_number: PB83-175620</p><p>page_range: 1-58</p><p>primary_author: Freeland, Mark S</p><p>title: National health expenditure growth in the 1980's: an aging population, new technologies, and increasing competition.</p><p>volume: 4</p><p>year_period: 1983 Mar</p>]]></description></item><item><title>The rise in the incidence of hospitalizations for the aged, 1967 to 1979.</title><pubDate>Mon, 04 Nov 2019 02:27:45 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191811</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191811</guid><description><![CDATA[<p>abstract: Since the beginning of the Medicare program in July 1966, the rate of hospitalization for persons age 65 and over has risen steadily. The rate grew more for the aged than for younger age groups. Because of concern about the appropriateness and cost of hospital care, this article examines the increase in hospitalizations for the aged and attempts to identify factors that may explain why the discharge rate rose more for the aged than for younger persons. The article shows that most of the increase in the discharge rate among the aged was associated with an increase in the percentage of persons using the hospital rather than with an increase in rate of multiple hospitalizations. There was also a large increase in the rate of hospital stays of short duration. Examination of changes in diagnostic and surgical case-mix showed that there was a large increase in vascular and cardiac surgeries. Changes in demographic composition and insurance coverage did not help explain the difference in the rate of growth of hospitalizations by age group. The increase in the rate of the aged being cared for in the hospital raises the question of the necessity and quality of the care they receive. Additional studies should focus on the nature and appropriateness of the hospital services rendered to the elderly.</p><p>authors: Deacon, Ronald W</p><p>issue_mesh: Adolescence : Adult : Age Factors : Aged : Child : Child, Preschool : Comparative Study : Diagnosis-Related Groups : Hospitalization/trends : Human : Infant : Infant, Newborn : Length of Stay/trends : Medicare/utilization : Middle Age : Patient Discharge/trends : Surgical Procedures, Operative/utilization : United States</p><p>issue_number: 3</p><p>ntis_number: PB82-203878</p><p>page_range: 21-40</p><p>primary_author: Lubitz, James</p><p>title: The rise in the incidence of hospitalizations for the aged, 1967 to 1979.</p><p>volume: 3</p><p>year_period: 1982 Mar</p>]]></description></item><item><title>Measurement Comparisons of the Medical Outcomes Study and Veterans SF-36 Health Survey</title><pubDate>Mon, 04 Nov 2019 02:27:45 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191781</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191781</guid><description><![CDATA[<p>page_range: 43-58</p><p>primary_author: Kazis, Lewis</p><p>title: Measurement Comparisons of the Medical Outcomes Study and Veterans SF-36 Health Survey</p><p>volume: 25</p><p>year_period: 2004 Summer</p>]]></description></item><item><title>Medicare Beneficiary's Use of Prescriptio Drug Discount Cards, CY 2002</title><pubDate>Mon, 04 Nov 2019 02:27:45 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191771</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191771</guid><description><![CDATA[<p>page_range: 91-94</p><p>primary_author: Eppig, Franklin</p><p>title: Medicare Beneficiary's Use of Prescriptio Drug Discount Cards, CY 2002</p><p>volume: 25</p><p>year_period: 2003 Winter</p>]]></description></item><item><title>State perspectives on health care reform: Oregon, Hawaii, Tennessee, and Rhode Island.</title><pubDate>Mon, 04 Nov 2019 02:27:45 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191364</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191364</guid><description><![CDATA[<p>abstract: The general consensus among States which have had their section 1115 demonstration projects approved is that there is no one best way to implement State health care reform. The Health Care Financing Administration (HCFA), however, wished to discern how States were accomplishing the task of implementing the demonstrations, and solicited responses from State representatives whose section 1115 demonstration waivers had been approved. The resulting article gives an overview of this implementation process from four State perspectives. Written by representatives from Oregon, Hawaii, Tennessee, and Rhode Island, the ideas presented here are indicative of the complex undertaking of State health care reform.</p><p>authors: Bianchi, Barbara; Bonnyman, Gordon; Greene, Clark; Leddy, Tricia</p><p>issue_mesh: Community Health Centers/organization &#x26; administration/utilization : Eligibility Determination : Hawaii : Health Care Reform/legislation &#x26; jurisprudence/organization &#x26; administration : Health Education : Health Priorities : Health Services Accessibility : Managed Care Programs/organization &#x26; administration/utilization : Management Information Systems : Medicaid/legislation &#x26; jurisprudence/organization &#x26; administration : Oregon : Public Relations : Rhode Island : State Health Plans/economics/legislation &#x26; jurisprudence : Tennessee : United States : United States Health Care Financing Administration</p><p>issue_number: 3</p><p>ntis_number: PB96-139530</p><p>page_range: 121-138</p><p>primary_author: Thorne, Jean I</p><p>title: State perspectives on health care reform: Oregon, Hawaii, Tennessee, and Rhode Island.</p><p>volume: 16</p><p>year_period: 1995 Spring</p>]]></description></item><item><title>Health care indicators.</title><pubDate>Mon, 04 Nov 2019 02:27:45 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191356</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191356</guid><description><![CDATA[<p>abstract: This regular feature of the journal includes a discussion of each of the following four topics: community hospital statistics; employment, hours, and earnings in the private health sector; health care prices; and national economic indicators. These statistics are valuable in their own right for understanding the relationship between the health care sector and the overall economy. In addition, they allow us to anticipate the direction and magnitude of health care cost changes prior to the availability of more comprehensive data.</p><p>authors: Sensenig, Arthur L</p><p>issue_mesh: Data Collection : Employment/statistics &#x26; numerical data : Fees and Charges/classification : Health Personnel/economics/statistics &#x26; numerical data : Hospitals, Community/economics/statistics &#x26; numerical data : Inflation, Economic/statistics &#x26; numerical data : Private Sector/statistics &#x26; numerical data : Salaries and Fringe Benefits/statistics &#x26; numerical data : United States : United States Health Care Financing Administration</p><p>issue_number: 2</p><p>ntis_number: PB99-106486</p><p>page_range: 201-231</p><p>primary_author: Donham, Carolyn S</p><p>title: Health care indicators.</p><p>volume: 16</p><p>year_period: 1994 Winter</p>]]></description></item><item><title>Development and testing of nursing home quality indicators.</title><pubDate>Mon, 04 Nov 2019 02:27:45 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191377</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191377</guid><description><![CDATA[<p>abstract: In this article, the authors report on the development and testing of a set of indicators of quality of care in nursing homes, using resident-level assessment data. These quality indicators (QIs) have been developed to provide a foundation for both external and internal quality-assurance (QA) and quality-improvement activities. The authors describe the development of the QIs, discuss their nature and characteristics, address the development of a QI-based quality-monitoring system (QMS), report on a pilot test of the QIs and the system, comment on methodological and current QI validation efforts, and conclude by raising further research and development issues.</p><p>authors: Arling, Greg; Clark, Brenda R; Collins, Ted; Karon, Sarita L; Ross, Richard; Sainfort, Francois</p><p>issue_mesh: Accidental Falls/statistics &#x26; numerical data : Decubitus Ulcer/epidemiology : Health Services Research/methods : Human : Nursing Homes/standards : Outcome and Process Assessment (Health Care) : Pilot Projects : Program Development : Quality Assurance, Health Care/organization &#x26; administration : Quality of Health Care/standards : Risk Factors : Support, U.S. Gov't, Non-P.H.S. : United States/epidemiology</p><p>issue_number: 4</p><p>ntis_number: PB99-106445</p><p>page_range: 107-127</p><p>primary_author: Zimmerman, David R</p><p>title: Development and testing of nursing home quality indicators.</p><p>volume: 16</p><p>year_period: 1995 Summer</p>]]></description></item><item><title>Medicare: advancing towards the 21st century, 1966-1996.</title><pubDate>Mon, 04 Nov 2019 02:27:45 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191463</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191463</guid><description><![CDATA[<p>authors: N/A</p><p>issue_mesh: Health Policy/history/trends : History of Medicine, 20th Cent. : Medicare/history/trends : Program Evaluation : United States : United States Health Care Financing Administration</p><p>issue_number: 2</p><p>ntis_number: PB98-110885</p><p>page_range: 1-237</p><p>primary_author: Vladeck, Bruce C</p><p>title: Medicare: advancing towards the 21st century, 1966-1996.</p><p>volume: 18</p><p>year_period: 1996 Winter</p>]]></description></item><item><title>Personal decisionmaking styles and long-term care choices.</title><pubDate>Mon, 04 Nov 2019 02:27:45 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191457</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191457</guid><description><![CDATA[<p>abstract: To learn more about how older people make decisions about long-term care (LTC), in-depth interviews were conducted with 63 elderly individuals and 56 of their relatives to obtain information on the decisionmaking process. This qualitative research showed that LTC decisionmaking does not always follow typical consumer decisionmaking models, in which a consumer seeks a product or service, selects among the alternatives, and assesses the choice. Further, the interviews yielded four long-term care decisionmaking styles among older adults related to their degree of planning or not planning. This study underscores the need to develop tailored communications for older people and their families aimed at encouraging appropriate and cost-effective use of LTC services.</p><p>authors: Andresen, Julie; Bloom, Diane L; Finn, Jeffrey</p><p>issue_mesh: Decision Making : Patient Acceptance of Health Care : Activities of Daily Living : Advance Directives : Aged : Aged, 80 and over : Communication : Family : Health Services Research/methods : Housing for the Elderly/utilization : Human : Interviews : Long-Term Care/utilization : Medicare : Nursing Homes/utilization : Public Policy : Support, Non-U.S. Gov't : United States</p><p>issue_number: 1</p><p>ntis_number: PB99-106494</p><p>page_range: 141-155</p><p>primary_author: Maloney, Susan K</p><p>title: Personal decisionmaking styles and long-term care choices.</p><p>volume: 18</p><p>year_period: 1996 Fall</p>]]></description></item><item><title>Medicare physician payment reform: its effect on access to care.</title><pubDate>Mon, 04 Nov 2019 02:27:45 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191413</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191413</guid><description><![CDATA[<p>abstract: This study analyzed a specific indicator condition, congestive heart failure (CHF), to see if there is evidence that physician payment reform (PPR) has had an effect on access to care for Medicare beneficiaries. If there was a decrease in access to ambulatory care services associated with PPR, one would expect to see an increase in hospitalizations for CHF in the period after PPR was implemented This analysis examined the trend in rates of hospitalization for CHF for the overall Medicare population and for selected vulnerable subgroups. No significant discontinuity was found in hospitalizations for CHF with the implementation of PPR.</p><p>authors: N/A</p><p>issue_mesh: Reimbursement Mechanisms : Aged : Aged, 80 and over : Blacks/statistics &#x26; numerical data : Evaluation Studies : Female : Health Services Accessibility/economics/trends : Heart Failure, Congestive/economics/therapy : Hospitalization/economics/statistics &#x26; numerical data : Human : Male : Medicare Part B/legislation &#x26; jurisprudence/utilization : Rural Population : United States/epidemiology</p><p>issue_number: 2</p><p>ntis_number: PB96-172663</p><p>page_range: 179-194</p><p>primary_author: Reilly, Thomas W</p><p>title: Medicare physician payment reform: its effect on access to care.</p><p>volume: 17</p><p>year_period: 1995 Winter</p>]]></description></item><item><title>Public Insurance Eligibility and Enrollment for Special Health Care Needs Children</title><pubDate>Mon, 04 Nov 2019 02:27:45 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191796</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191796</guid><description><![CDATA[<p>page_range: 119-135</p><p>primary_author: Davidoff, Amy</p><p>title: Public Insurance Eligibility and Enrollment for Special Health Care Needs Children</p><p>volume: 26</p><p>year_period: 2004 Fall</p>]]></description></item><item><title>Health care use by Hispanic adults: financial vs. non-financial determinants.</title><pubDate>Mon, 04 Nov 2019 02:27:45 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191407</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191407</guid><description><![CDATA[<p>abstract: The purpose of this article is to assess the relative effects of financial and cultural factors, namely language spoken, on health care use by Hispanic adults. Using a national sample, we examine the determinants of having a usual source of care (USOC), use of physician visits, and likelihood of having blood pressure checked. Multivariate analysis reveals the following: Monolingual Spanish speakers were not significantly different from English speakers for the three dependent variables; having private insurance or Medicaid was positively related to all three dependent variables. We conclude that financial factors primarily insurance--remain as the paramount barriers to care.</p><p>authors: Albers, Leigh A; Berk, Marc L</p><p>issue_mesh: Adult : Aged : Blood Pressure : Health Care Costs : Health Services Accessibility/economics/statistics &#x26; numerical data : Health Services Research : Health Services/utilization : Hispanic Americans/statistics &#x26; numerical data : Human : Hypertension/diagnosis : Insurance, Health/utilization : Language : Likelihood Functions : Medicaid/utilization : Medicare/utilization : Middle Age : Office Visits/statistics &#x26; numerical data : Patient Acceptance of Health Care/statistics &#x26; numerical data : Socioeconomic Factors : Support, Non-U.S. Gov't : United States</p><p>issue_number: 2</p><p>ntis_number: PB96-172663</p><p>page_range: 71-88</p><p>primary_author: Schur, Claudia L</p><p>title: Health care use by Hispanic adults: financial vs. non-financial determinants.</p><p>volume: 17</p><p>year_period: 1995 Winter</p>]]></description></item><item><title>Factors that may explain interstate differences in certificate-of-need decisions.</title><pubDate>Mon, 04 Nov 2019 02:27:44 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191819</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191819</guid><description><![CDATA[<p>abstract: A major difficulty in conducting studies of the impact of certificate-of-need programs is in accounting for interstate differences in program characteristics. This paper addresses this problem by examining the empirical relationship between various characteristics of certificate-of-need programs and program decisions, measured in terms of the approvals of hospital capital projects. Aggregate data on capital expenditure approvals and net bed change approvals for 28 States are correlated with an index of each State's regulatory characteristics that was developed in an earlier study. In addition, a multivariate model of certificate-of-need approvals is estimated in which certain measures associated with the need for hospital capital in a State are introduced, along with the indices of regulatory characteristics, to explain interstate differences in regulatory characteristics, to explain interstate differences in program decisions. The results of this analysis indicate that although regulatory characteristics are significantly correlated with the relative number of new beds approved, they have little correlation with total capital expenditure approvals. Moreover, variables reflecting the need for new hospital capital in a State, such as past population growth and existing hospital capacity, appear to be more important than regulatory characteristics in explaining the relative amount of capital approvals.</p><p>authors: Schoeman, Milton; Traxler, Herbert</p><p>issue_mesh: Capital Expenditures : Economics : Certificate of Need/legislation &#x26; jurisprudence : Comparative Study : Regional Health Planning/legislation &#x26; jurisprudence : Regression Analysis : United States</p><p>issue_number: 4</p><p>ntis_number: PB82-219213</p><p>page_range: 87-94</p><p>primary_author: Begley, Charles E</p><p>title: Factors that may explain interstate differences in certificate-of-need decisions.</p><p>volume: 3</p><p>year_period: 1982 Jun</p>]]></description></item><item><title>Medicaid Spending and Utilization for Central Nervous System Drugs</title><pubDate>Mon, 04 Nov 2019 02:27:44 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191792</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191792</guid><description><![CDATA[<p>page_range: 57-73</p><p>primary_author: Baugh, David</p><p>title: Medicaid Spending and Utilization for Central Nervous System Drugs</p><p>volume: 26</p><p>year_period: 2004 Fall</p>]]></description></item><item><title>Medicaid Prescription Drug Spending in the 1990s: A Decade of Change</title><pubDate>Mon, 04 Nov 2019 02:27:44 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191773</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191773</guid><description><![CDATA[<p>page_range: 5-23</p><p>primary_author: Baugh, David</p><p>title: Medicaid Prescription Drug Spending in the 1990s: A Decade of Change</p><p>volume: 25</p><p>year_period: 2004 Spring</p>]]></description></item><item><title>Predictability of Prescription Drug Expenditures for Medicare Beneficiaries</title><pubDate>Mon, 04 Nov 2019 02:27:44 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191769</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191769</guid><description><![CDATA[<p>page_range: 37-46</p><p>primary_author: Wrobel, Marian</p><p>title: Predictability of Prescription Drug Expenditures for Medicare Beneficiaries</p><p>volume: 25</p><p>year_period: 2003 Winter</p>]]></description></item><item><title>Options for change under Medicare: impact of a cap on catastrophic illness expense.</title><pubDate>Mon, 04 Nov 2019 02:27:44 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191845</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191845</guid><description><![CDATA[<p>abstract: This study analyzes the total deductibles and coinsurance Medicare beneficiaries accrued in 1980. The study shows that Part B services accounted for 70 percent of all liability and Part A for 30 percent. Only 21 percent of enrollees exceeded $270 in liability from Part A and Part B combined. In 1980, if every enrollee had paid a surcharge of about $70, all liability over $270 could have been capped--without any additional program outlays. Similarly, projections for 1984 indicate that a surcharge of $98 could cap all liability over $800. For Part B alone, a surcharge of $113 could cover all liability over $200.</p><p>authors: Beebe, James C; Prihoda, Ronald</p><p>issue_mesh: Deductibles and Coinsurance : Catastrophic Illness/economics : Costs and Cost Analysis : Medicare/economics : Rate Setting and Review/economics : United States</p><p>issue_number: 1</p><p>ntis_number: PB84-125715</p><p>page_range: 33-43</p><p>primary_author: Gornick, Marian</p><p>title: Options for change under Medicare: impact of a cap on catastrophic illness expense.</p><p>volume: 5</p><p>year_period: 1983 Fall</p>]]></description></item><item><title>National health expenditures, 1980.</title><pubDate>Mon, 04 Nov 2019 02:27:44 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191799</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191799</guid><description><![CDATA[<p>abstract: The United States spent an estimated $247 billion for health care in 1980 (Figure 1), an amount equal to 9.4 percent of the Gross National Product (GNP). Highlights of the figures that underlie this estimate include the following: Health care expenditures in 1980 accelerated at a time when the economy as a whole exhibited sluggish growth. The 9.4 percent share of the GNP was a dramatic increase from the 8.9 percent share in 1979. Health care expenditures amounted to $1,067 per person in 1980 (Table 1). Of that amount, $450, or 42.2 percent, came from public funds. Expenditures for health care included $64.9 billion in premiums to private health insurance, $70.9 billion in Federal payments, and $33.3 billion in State and local government funds (Table 2). Hospital care accounted for 40.3 percent of total health care spending in 1980 (Table 3). These expenditures increased 16.2 percent between 1979 and 1980, to a level of $99.6 billion. Spending for the services of physicians increased 14.5 percent to $46.6 billion, 18.9 percent of all health care spending. All third parties combined--private health insurers, governments, philanthropists, and industry--financed 67.6 percent of the $217.9 billion spent for personal health care in 1980 (Table 4), ranging from 90.9 percent of hospital care services to 62.7 percent of physicians' services and 38.5 percent of the remainder (Table 5). Direct payments by consumers reached $70.6 billion in 1980 (Table 6). This accounted for 32.4 percent of all personal health care expenses. Outlays for health care benefits by the Medicare and Medicaid programs totaled $60.6 billion, including $35.8 billion for hospital care. The two programs combined to pay for 27.8 percent of all personal health care in the nation (Table 7).</p><p>authors: Waldo, Daniel R</p><p>issue_mesh: Health Expenditures : Insurance, Health, Reimbursement : Personal Health Services/economics : United States</p><p>issue_number: 1</p><p>ntis_number: PB82-130170</p><p>page_range: 1-54</p><p>primary_author: Gibson, Robert M</p><p>title: National health expenditures, 1980.</p><p>volume: 3</p><p>year_period: 1981 Sep</p>]]></description></item><item><title>General revenue financing of Medicare: who will bear the burden?</title><pubDate>Mon, 04 Nov 2019 02:27:44 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191810</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191810</guid><description><![CDATA[<p>abstract: Two recent national advisory committees on Social Security recommended major shifts in Medicare financing to preserve the financial viability of the Social Security trust funds. This paper estimates the income redistribution consequences of the two proposals, in contrast to current law, using a micro-simulation model of taxes and premiums. These estimates show that while the current Medicare financing package is mildly progressive, the new proposals would substantially increase income redistribution under the program. Two insights provided by separate estimates, for families headed by the elderly (persons age 65 or over) versus those headed by the non-elderly, are: 1) the surprisingly large Medicare tax burdens on families headed by the elderly under the current financing package of payroll taxes, general revenues, and enrollee premiums; and 2) the substantial increases in these burdens under proposed shifts toward increased general revenue financing.</p><p>authors: Long, Stephen H</p><p>issue_mesh: Family : Income : Income Tax : Aged : Human : Medicare/economics : Models, Theoretical : Social Security/economics : United States</p><p>issue_number: 3</p><p>ntis_number: PB82-203878</p><p>page_range: 13-20</p><p>primary_author: Johnson, Janet L</p><p>title: General revenue financing of Medicare: who will bear the burden?</p><p>volume: 3</p><p>year_period: 1982 Mar</p>]]></description></item><item><title>Prospective Payment for Medicare Inpatient Psychiatric Care: Assessing the Alternatives</title><pubDate>Mon, 04 Nov 2019 02:27:44 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191794</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191794</guid><description><![CDATA[<p>page_range: 85-101</p><p>primary_author: Cotterill, Philip</p><p>title: Prospective Payment for Medicare Inpatient Psychiatric Care: Assessing the Alternatives</p><p>volume: 26</p><p>year_period: 2004 Fall</p>]]></description></item><item><title>Social and economic incentives for family caregivers.</title><pubDate>Mon, 04 Nov 2019 02:27:44 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191854</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191854</guid><description><![CDATA[<p>abstract: The recent emphasis on developing programs and policies to support families who care for aged relatives makes it important to understand the families' receptivity to the specific social and economic incentives under consideration. The research reported in this paper draws on the experiences of 203 individuals identified as the primary caregiver to an aged frail relative currently receiving home care or day care services in New York City. As part of a larger study of caregiving behavior, respondents were asked to rank their preferences for various service and economic support programs. Findings indicate that family caregivers perceive service and social supports, specifically medical care and homemaker service, as more crucial than both direct and indirect financial incentives. Furthermore, the issue of economic incentives elicited an extremely negative reaction from a significant minority who refused to consider such support in their personal family situations. The analysis indicated that the caregiver's background characteristics were not critical in differentiating caregivers who select either a service or an economic incentive. Among the set of variables defining the current caregiving situation, only sex of the aged relative and utilization of home care services were significantly related to choice of program. Respondents caring for females and high service utilizers were more likely to prefer service supports. Relevance of findings to current policy initiatives regarding financial incentives to families are presented.</p><p>authors: Shindelman, Lois W</p><p>issue_mesh: Aged : Analysis of Variance : Family Health : Financing, Personal/utilization : Health Services for the Aged/economics : Health Services Needs and Demand/economics : Home Care Services/economics : Human : New York City : Socioeconomic Factors : Support, U.S. Gov't, P.H.S.</p><p>issue_number: 2</p><p>ntis_number: PB84-185321</p><p>page_range: 25-33</p><p>primary_author: Horowitz, Amy</p><p>title: Social and economic incentives for family caregivers.</p><p>volume: 5</p><p>year_period: 1983 Winter</p>]]></description></item><item><title>Effects of Managed Care on Southern Youth's Behavioral Services</title><pubDate>Mon, 04 Nov 2019 02:27:44 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191790</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191790</guid><description><![CDATA[<p>page_range: 23-41</p><p>primary_author: Saunders, Robert</p><p>title: Effects of Managed Care on Southern Youth's Behavioral Services</p><p>volume: 26</p><p>year_period: 2004 Fall</p>]]></description></item><item><title>Use of HOS Data in Florida</title><pubDate>Mon, 04 Nov 2019 02:27:44 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191784</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191784</guid><description><![CDATA[<p>page_range: 93-104</p><p>primary_author: McDonald, Kathie</p><p>title: Use of HOS Data in Florida</p><p>volume: 25</p><p>year_period: 2004 Summer</p>]]></description></item><item><title>Impact of an all-or-nothing assignment requirement under Medicare.</title><pubDate>Mon, 04 Nov 2019 02:27:44 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191840</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191840</guid><description><![CDATA[<p>abstract: In an effort to raise assignment rates, some policymakers have considered dropping Medicare's case-by-case assignment option. Physicians would have to decide whether to accept all of their patients on assignment, or none of them. In a 1976 national survey, over two-thirds of the physicians stated they would take none of their patients on assignment if forced to choose. Simulation analysis showed that in that event, assignment rates nationwide would fall almost 10 percent. The mean supply of assigned visits would actually increase 11 percent for general practitioners, while decreasing 12-25 percent for general surgeons, internists, and obstetricians/gynecologists.</p><p>authors: Cromwell, Jerry L</p><p>issue_mesh: Decision Making : Deductibles and Coinsurance : Physicians : Family Practice/economics : Fees, Medical : Human : Medicare/utilization : Specialties, Medical/economics : United States</p><p>issue_number: 4</p><p>ntis_number: PB83-220657</p><p>page_range: 59-78</p><p>primary_author: Mitchell, Janet B</p><p>title: Impact of an all-or-nothing assignment requirement under Medicare.</p><p>volume: 4</p><p>year_period: 1983 Summer</p>]]></description></item><item><title>Hospital and health maintenance organization financial agreements for inpatient services: a case study of the Minneapolis/St. Paul area.</title><pubDate>Mon, 04 Nov 2019 02:27:44 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191841</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191841</guid><description><![CDATA[<p>abstract: With nearly a quarter of the population enrolled in Health Maintenance Organizations (HMOs) the Minneapolis/St. Paul metropolitan area provides a unique opportunity for studies dealing with the effects of prepaid health plans on the health care marketplace. This study explores one aspect of that market; discounts obtained by HMOs for hospital inpatient service. Using information gathered from structured interviews with the 7 HMOs and 30 hospitals in the Twin Cities area, the study addressed three areas of inquiry: (1) the nature of discount contracts between hospitals and HMOs, (2) the roles played by each party in initiating the contracts, and (3) factors influencing the establishment of the contracts. While each of the HMOs was found to have at least one hospital contract under which they received inpatient services for other than full-billed charges, the amount of the discount was not substantial in the majority of cases. Other factors such as hospital location and ability to provide a full range of services appear to be as important as financial discounts when HMOs select a hospital for inpatient services. It appears that hospitals played the lead role in initiating hospital/HMO contracts during the formative HMO years, but this initiative shifted to the HMOs as they gained market shares and bargaining power. Hospitals and HMOs agree that the most important factor influencing hospital willingness to consider discount contracts was and still is the surplus bed availability in the area. This surplus of beds has been exacerbated by a continued decline in hospital utilization. These conditions coupled with increased HMO market shares has recently resulted in intensified contract negotiations and further discounts for inpatient services.</p><p>authors: Countryman, Dennis D; Pitt, Laura</p><p>issue_mesh: Hospital Administration : Contract Services/economics : Financial Management/economics : Health Maintenance Organizations/organization &#x26; administration : Minnesota : Organizational Affiliation/economics</p><p>issue_number: 4</p><p>ntis_number: PB83-220657</p><p>page_range: 79-84</p><p>primary_author: Kralewski, John E</p><p>title: Hospital and health maintenance organization financial agreements for inpatient services: a case study of the Minneapolis/St. Paul area.</p><p>volume: 4</p><p>year_period: 1983 Summer</p>]]></description></item><item><title>Trends I Nursing Home Expenses, 1987-1996</title><pubDate>Mon, 04 Nov 2019 02:27:44 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191764</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191764</guid><description><![CDATA[<p>page_range: 99-114</p><p>primary_author: Rhoades, Jeffrey</p><p>title: Trends I Nursing Home Expenses, 1987-1996</p><p>volume: 25</p><p>year_period: 2003 Fall</p>]]></description></item><item><title>Managing programs for the elderly: design of a social information systems.</title><pubDate>Mon, 04 Nov 2019 02:27:44 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191853</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191853</guid><description><![CDATA[<p>abstract: This paper describes a comprehensive approach to assembling a health care information system to monitor programs for the elderly and disabled in a cost effective manner. The Social Information System (SIS) described in the paper was implemented for the evaluation of the New York State Long-Term Home Health Care Program (LTHHCP). This evaluation required the collection and organization of large amounts of client specific data, including claims, clinical and programmatic data. Sources for these data included client medical records, Medicare, Medicaid, and the New York State Food Stamps, Public Assistance, Title XX, and Energy Assistance Programs. Recommendations are made regarding client identification, data elements, access, and structure of the data base.</p><p>authors: Burke, Robert; Pratter, Frederick</p><p>issue_mesh: Home Care Services/organization &#x26; administration : Human : Information Systems/organization &#x26; administration : Long-Term Care/organization &#x26; administration : Management Information Systems/organization &#x26; administration : New York : Social Work/organization &#x26; administration : Support, U.S. Gov't, P.H.S.</p><p>issue_number: 2</p><p>ntis_number: PB84-185321</p><p>page_range: 11-24</p><p>primary_author: Birnbaum, Howard</p><p>title: Managing programs for the elderly: design of a social information systems.</p><p>volume: 5</p><p>year_period: 1983 Winter</p>]]></description></item><item><title>Paying the hospital: foreign lessons for the United States.</title><pubDate>Mon, 04 Nov 2019 02:27:44 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191843</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191843</guid><description><![CDATA[<p>abstract: This special report synthesizes the findings of a Health Care Financing Administration grant which allowed the author to analyze hospital finance in six foreign countries and in the United States. The author identified the principal problems facing hospital owners, carriers, and governments in the United States, and he conducted lengthy field work abroad to learn how each country dealt with the same problems. One set of the author's conclusions makes more clear issues that are debated in the United States, such as the meaning of "cost-based reimbursement" and "prospective reimbursement". Some of the author's findings show the difficulty of implementing policies often proposed in the United States, such as incentive reimbursement schemes. Other findings of the author show the conditions necessary for cost containment, such as strong representation of consumers and firm political will by government.</p><p>authors: N/A</p><p>issue_mesh: Costs and Cost Analysis : Economics, Hospital/trends : Europe : Financial Management, Hospital/trends : Financial Management/trends : Reimbursement Mechanisms : United States</p><p>issue_number: 4</p><p>ntis_number: PB83-220657</p><p>page_range: 99-110</p><p>primary_author: Glaser, William A</p><p>title: Paying the hospital: foreign lessons for the United States.</p><p>volume: 4</p><p>year_period: 1983 Summer</p>]]></description></item><item><title>Beneficiary Reported Experience and Voluntary Disenrollment in Medicare Managed Care</title><pubDate>Mon, 04 Nov 2019 02:27:44 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191761</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191761</guid><description><![CDATA[<p>page_range: 55-66</p><p>primary_author: Bender, Randall</p><p>title: Beneficiary Reported Experience and Voluntary Disenrollment in Medicare Managed Care</p><p>volume: 25</p><p>year_period: 2003 Fall</p>]]></description></item><item><title>Kaiser-Permanente's Medicare Plus Project: a successful Medicare prospective payment demonstration.</title><pubDate>Mon, 04 Nov 2019 02:27:44 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191842</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191842</guid><description><![CDATA[<p>abstract: The Medicare Plus project of the Oregon Region Kaiser-Permanente Medical Care Program was designed as a model for prospective payment to increase Health Maintenance Organization (HMO) participation in the Medicare program. The project demonstrated that it is possible to design a prospective payment system that costs the Medicare program less than services purchased in the community from fee-for-service providers; would provide appropriate payment to the HMO; and in addition, creates a "savings" to return to beneficiaries in the form of comprehensive benefits to motivate them to enroll in the HMO. Medicare Plus was highly successful in recruiting 5,500 new and 1,800 conversion members into the demonstration, through use of a media campaign, a recruitment brochure, and a telephone information center. Members recruited were a representative age and geographic cross section of the senior citizen population in the Portland, Oregon metropolitan area. Utilization of inpatient services by Medicare Plus members in the first full year (1981) was 1679 days per thousand members and decreased to 1607 in the second full year (1982). New members made an average of eight visits per year to ambulatory care facilities.</p><p>authors: Carpenter Jr, Theodore M; Cooper, William J; Fischer, Thomas S; Lamb, Sarah J; Marks, Sylvia D</p><p>issue_mesh: Prospective Payment System : Reimbursement Mechanisms : Aged : Health Maintenance Organizations/economics : Health Services/utilization : Human : Medicare/organization &#x26; administration : Models, Theoretical : Oregon : Pilot Projects : United States : United States Health Care Financing Administration</p><p>issue_number: 4</p><p>ntis_number: PB83-220657</p><p>page_range: 85-97</p><p>primary_author: Greenlick, Merwyn R</p><p>title: Kaiser-Permanente's Medicare Plus Project: a successful Medicare prospective payment demonstration.</p><p>volume: 4</p><p>year_period: 1983 Summer</p>]]></description></item><item><title>Bioactuarial models of national mortality time series data.</title><pubDate>Mon, 04 Nov 2019 02:27:44 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191814</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191814</guid><description><![CDATA[<p>abstract: The incidence and prevalence of chronic degenerative disease in America's elderly population are important determinants of the need for long-term care health services. Though a wide range of data on disease incidence and prevalence is available from a variety of different health studies, a Congressional Budget Office study (1977) concluded that data limitations are a major factor in the lack of precise national long-term care cost estimates. In this paper, we present a modeling strategy to make better use of existing data by using biomedically motivated actuarial models to integrate multiple data sources into a comprehensive model of population health dynamics. The development of a specific model for application to a disease of interest involves three distinct phases. First, biomedical evidence and data are used to specify a cohort model of chronic disease morbidity and mortality. Second, the model is fitted to cohort mortality data with estimates of its parameters being derived by maximum likelihood procedures. Third, the morbidity distribution in the national population is generated from the parameter estimates. The model is used to examine lung cancer morbidity and mortality patterns for U. S. white and non-white males in 1977. A review of these patterns suggests that, based on current concepts of lung cancer incidence and natural history, over 2 percent of white males in the United States have lung cancer at some stage of development, though most of this prevalence is pre-clinical.</p><p>authors: Stallard, Eric</p><p>issue_mesh: Actuarial Analysis : Adolescence : Adult : Aged : Child : Child, Preschool : Chronic Disease/classification/epidemiology/mortality : Comparative Study : Human : Infant : Lung Neoplasms/epidemiology/mortality : Male : Middle Age : Models, Theoretical : Stochastic Processes : Support, U.S. Gov't, P.H.S. : Time and Motion Studies : United States</p><p>issue_number: 3</p><p>ntis_number: PB82-203878</p><p>page_range: 89-106</p><p>primary_author: Manton, Kenneth G</p><p>title: Bioactuarial models of national mortality time series data.</p><p>volume: 3</p><p>year_period: 1982 Mar</p>]]></description></item><item><title>Public policy and pharmaceutical innovation.</title><pubDate>Mon, 04 Nov 2019 02:27:43 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191823</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191823</guid><description><![CDATA[<p>abstract: Historically, new drug introductions have played a central role in medical progress and the availability of cost-effective therapies. Nevertheless, public policy toward pharmaceuticals has been characterized in recent times by increasingly stringent regulatory controls, shorter effective patent terms, and increased encouragement of generic product usage. This has had an adverse effect on the incentives and capabilities of firms to undertake new drug research and development activity. The industry has experienced sharply rising research and development costs, declining annual new drug introductions, and fewer independent sources of drug development. This paper considers the effects of government regulatory policies on the pharmaceutical innovation process from several related perspectives. It also examines the merits of current public policy proposals designed to stimulate drug innovation including patent restoration and various regulatory reform measures.</p><p>authors: N/A</p><p>issue_mesh: Drug Industry : Public Policy : Diffusion of Innovation : Legislation, Drug/trends : Research Support : United States : United States Food and Drug Administration</p><p>issue_number: 1</p><p>ntis_number: PB83-104414</p><p>page_range: 75-87</p><p>primary_author: Grabowski, Henry G</p><p>title: Public policy and pharmaceutical innovation.</p><p>volume: 4</p><p>year_period: 1982 Sep</p>]]></description></item><item><title>Reliability and validity in hospital case-mix measurement.</title><pubDate>Mon, 04 Nov 2019 02:27:43 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191829</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191829</guid><description><![CDATA[<p>abstract: There is widespread interest in the development of a measure of hospital output. This paper describes the problem of measuring the expected cost of the mix of inpatient cases treated in a hospital (hospital case-mix) and a general approach to its solution. The solution is based on a set of homogeneous groups of patients, defined by a patient classification system, and a set of estimated relative cost weights corresponding to the patient categories. This approach is applied to develop a summary measure of the expected relative costliness of the mix of Medicare patients treated in 5,576 participating hospitals. The Medicare case-mix index is evaluated by estimating a hospital average cost function. This provides a direct test of the hypothesis that the relationship between Medicare case-mix and Medicare cost per case is proportional. The cost function analysis also provides a means of simulating the effects of classification error on our estimate of this relationship. Our results indicate that this general approach to measuring hospital case-mix provides a valid and robust measure of the expected cost of a hospital's case-mix.</p><p>authors: Vertrees, James C</p><p>issue_mesh: Costs and Cost Analysis/methods : Diagnosis-Related Groups : Abstracting and Indexing : Diagnostic Errors : Medicare/economics : Models, Theoretical : Regression Analysis : United States</p><p>issue_number: 2</p><p>ntis_number: PB83-149815</p><p>page_range: 101-128</p><p>primary_author: Pettengill, Julian</p><p>title: Reliability and validity in hospital case-mix measurement.</p><p>volume: 4</p><p>year_period: 1982 Dec</p>]]></description></item><item><title>Medicaid Drugs</title><pubDate>Mon, 04 Nov 2019 02:27:43 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191772</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191772</guid><description><![CDATA[<p>page_range: 1-4</p><p>primary_author: Poisal, John</p><p>title: Medicaid Drugs</p><p>volume: 25</p><p>year_period: 2004 Spring</p>]]></description></item><item><title>Survey-based indices for nursing home quality incentive reimbursement.</title><pubDate>Mon, 04 Nov 2019 02:27:43 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191834</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191834</guid><description><![CDATA[<p>abstract: Incentive payments are a theoretically appealing complement to nursing home quality assurance systems that rely on regulatory enforcement. However, the practical aspects of incentive program design are not yet well understood. After reviewing the rationale for incentive approaches and recent State and Federal initiatives, the article considers a basic program design issue: creating an index of nursing home quality. It focuses on indices constructed from routine licensure and certification survey results because State initiatives have relied heavily on these readily accessible data. It also suggests a procedure for creating a survey-based index and discusses a sampling of implementation issues.</p><p>authors: N/A</p><p>issue_mesh: Data Collection : Reimbursement Mechanisms : Reimbursement, Incentive : Abstracting and Indexing : Health Plan Implementation/economics : Nursing Homes/standards : Quality Assurance, Health Care/economics : Support, U.S. Gov't, P.H.S. : United States</p><p>issue_number: 3</p><p>ntis_number: PB83-175620</p><p>page_range: 83-90</p><p>primary_author: Willemain, Thomas R</p><p>title: Survey-based indices for nursing home quality incentive reimbursement.</p><p>volume: 4</p><p>year_period: 1983 Mar</p>]]></description></item><item><title>The effects of prospective reimbursement programs on hospital adoption and service sharing.</title><pubDate>Mon, 04 Nov 2019 02:27:43 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191827</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191827</guid><description><![CDATA[<p>abstract: A previous article in this journal (Coelen and Sullivan, 1981) reported new evidence that many State hospital prospective reimbursement (PR) programs have been successful in reducing hospital cost inflation. Limiting proliferation of redundant technologies and community services may be one method of reducing this cost inflation. Data compiled from a sample of over 2,500 hospitals in 15 rate-setting and other States between 1969 and 1978 were used to determine PR's effect on both service adoption and sharing. Evidence indicates a consistent, retarding effect on all services for New York, the country's oldest, most stringent program. Several other States, notably Minnesota, Maryland, New Jersey, Washington, and Wisconsin showed retarding effects on costly rapidly diffusing services such as open heart surgery, intensive care units (ICUs), and social work, as well as accelerating the phasing-out of redundant services, such as the premature nursery. We found no consistent, significant effects on service sharing.</p><p>authors: Kanak, James</p><p>issue_mesh: Prospective Payment System : Rate Setting and Review : Reimbursement Mechanisms : Data Collection : Hospital Planning/trends : Hospital Shared Services/utilization : Models, Theoretical : Support, U.S. Gov't, P.H.S. : United States</p><p>issue_number: 2</p><p>ntis_number: PB83-149815</p><p>page_range: 67-88</p><p>primary_author: Cromwell, Jerry L</p><p>title: The effects of prospective reimbursement programs on hospital adoption and service sharing.</p><p>volume: 4</p><p>year_period: 1982 Dec</p>]]></description></item><item><title>National health expenditures, 1982.</title><pubDate>Mon, 04 Nov 2019 02:27:43 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191844</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191844</guid><description><![CDATA[<p>abstract: Rapid growth in the share of the nation's gross national product devoted to health expenditure has heightened concern over the survival of government entitlement programs and has led to debate of the desirability of current methods of financing health care. In this article, the authors present the data at the heart of the issue, quantifying spending for various types of health care in 1982 and discussing the sources of funds for that spending.</p><p>authors: Levit, Katharine R; Waldo, Daniel R</p><p>issue_mesh: Health Expenditures : Insurance, Health : Models, Theoretical : Personal Health Services/economics : United States</p><p>issue_number: 1</p><p>ntis_number: PB84-125715</p><p>page_range: 1-32</p><p>primary_author: Gibson, Robert M</p><p>title: National health expenditures, 1982.</p><p>volume: 5</p><p>year_period: 1983 Fall</p>]]></description></item><item><title>Private health insurance plans in 1978 and 1979: a review of coverage, enrollment, and financial experience.</title><pubDate>Mon, 04 Nov 2019 02:27:43 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191800</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191800</guid><description><![CDATA[<p>abstract: The private health insurance industry collected $55.9 billion in premiums in 1979 and returned $50.2 billion in benefits to its subscribers. Premiums rose 12.4 percent, slightly faster than in 1978 when premiums rose 11.4 percent, to $49.7 billion. Benefits rose 11.4 percent in 1979, down from the 12.6 rate in 1978. After operating expenses were deducted, the industry showed underwriting losses of $1.4 billion in 1979 and $1.5 billion in 1978. About 78 percent of the population was insured for hospital care, 76 percent for x-ray and laboratory examinations, and about 76 percent for surgical services in 1979. Smaller percentages had coverage for other types of care. An estimated 64 percent of the aged bought private hospital insurance, and about 43 percent bought surgical insurance, mostly to supplement Medicare benefits. An estimated 12 percent of persons under age 65 had no protection against the cost of hospital care either through private insurance or a public program such as Medicare or Medicaid.</p><p>authors: Arnett 3d, Ross H</p><p>issue_mesh: Insurance Benefits : Insurance Carriers/economics : Insurance, Health/economics : Insurance/economics : United States</p><p>issue_number: 1</p><p>ntis_number: PB82-130170</p><p>page_range: 55-87</p><p>primary_author: Carroll, Marjorie S</p><p>title: Private health insurance plans in 1978 and 1979: a review of coverage, enrollment, and financial experience.</p><p>volume: 3</p><p>year_period: 1981 Sep</p>]]></description></item><item><title>Duplicate health insurance coverage: determinants of variation across states.</title><pubDate>Mon, 04 Nov 2019 02:27:43 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191817</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191817</guid><description><![CDATA[<p>abstract: Although it is recognized that many people have duplicate private health insurance coverage, either through separate purchase or as health benefits in multi-earner families, there has been little analysis of the factors determining duplicate coverage rates. A new data source, the Survey of Income and Education, offers a comparison with the only previous source of state level data, the estimates from the Health Insurance Association of America. The R2 between the two sets is only .3 and certain problems can be traced to the methodology underlying the HIAA figures. Using figures for gross and net coverage, the ratio of total policies to people with private coverage ranges from .94 in Utah to 1.53 in Illinois. Measures of industry distribution, per capita income and employment explain a large portion of the variance, but it appears that these factors operate in opposite directions for group and non-group policies. Similar sociodemographic variables also explain net coverage. These findings have substantial implications for research and the structuring of employee health benefits.</p><p>authors: Maerki, Susan C</p><p>issue_mesh: Analysis of Variance : Comparative Study : Educational Status : Health Benefit Plans, Employee/utilization : Income : Insurance, Health/utilization : Socioeconomic Factors : Support, U.S. Gov't, P.H.S. : United States</p><p>issue_number: 4</p><p>ntis_number: PB82-219213</p><p>page_range: 45-66</p><p>primary_author: Luft, Harold S</p><p>title: Duplicate health insurance coverage: determinants of variation across states.</p><p>volume: 3</p><p>year_period: 1982 Jun</p>]]></description></item><item><title>Coexisting Illness and Heart Disease Among Elderly Medicare Managed Care Enrollees</title><pubDate>Mon, 04 Nov 2019 02:27:43 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191785</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191785</guid><description><![CDATA[<p>page_range: 105-116</p><p>primary_author: Bierman, Arlene</p><p>title: Coexisting Illness and Heart Disease Among Elderly Medicare Managed Care Enrollees</p><p>volume: 25</p><p>year_period: 2004 Summer</p>]]></description></item><item><title>Generic Drug cost containment in Medicaid: Lessons from Five State MAC Programs</title><pubDate>Mon, 04 Nov 2019 02:27:43 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191774</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191774</guid><description><![CDATA[<p>page_range: 25-34</p><p>primary_author: Abramson, Richard</p><p>title: Generic Drug cost containment in Medicaid: Lessons from Five State MAC Programs</p><p>volume: 25</p><p>year_period: 2004 Spring</p>]]></description></item><item><title>The Medicare Economic Index: its background and beginnings.</title><pubDate>Mon, 04 Nov 2019 02:27:43 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191803</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191803</guid><description><![CDATA[<p>authors: McMenamin, Peter</p><p>issue_mesh: Fees, Medical : Insurance, Physician Services/economics : Medicare/economics : United States</p><p>issue_number: 1</p><p>ntis_number: PB82-130170</p><p>page_range: 137-140</p><p>primary_author: Dutton Jr, Benson L</p><p>title: The Medicare Economic Index: its background and beginnings.</p><p>volume: 3</p><p>year_period: 1981 Sep</p>]]></description></item><item><title>Case-mix differences between hospital outpatient departments and private practice.</title><pubDate>Mon, 04 Nov 2019 02:27:43 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191824</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191824</guid><description><![CDATA[<p>abstract: The belief that patients seen in hospital outpatient departments are sicker than those patients seen by private practice physicians is examined in this article. A large scale data set developed by Robert Mendenhall at the University of Southern California and modeled on the National Ambulatory Medical Care Survey (NAMCS) is used for secondary analysis. Differences in case-mix complexity were found to be slight, using two separate techniques.</p><p>authors: Altman, Stuart</p><p>issue_mesh: Costs and Cost Analysis : Diagnosis-Related Groups : Ambulatory Care : Family Practice : Internal Medicine : Outpatient Clinics, Hospital/utilization : Pediatrics : Private Practice/utilization : Support, Non-U.S. Gov't : Support, U.S. Gov't, P.H.S. : Time and Motion Studies : United States</p><p>issue_number: 1</p><p>ntis_number: PB83-104414</p><p>page_range: 89-98</p><p>primary_author: Lion, Joanna</p><p>title: Case-mix differences between hospital outpatient departments and private practice.</p><p>volume: 4</p><p>year_period: 1982 Sep</p>]]></description></item><item><title>Summary of the 1983 annual reports of the Medicare Board of Trustees.</title><pubDate>Mon, 04 Nov 2019 02:27:43 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191852</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191852</guid><description><![CDATA[<p>abstract: This summary presents an overview of the information contained in the annual reports of the trustees required under Title XVIII of the Social Security Act, Health Insurance for the Aged and Disabled, commonly known as Medicare. There are two basic programs under Medicare: Hospital insurance (HI), which pays for inpatient hospital care and other related care of those 65 years of age and over and of the long-term disabled. Supplementary medical insurance (SMI), which pays for physicians' services, outpatient hospital services, and other medical expenses of those 65 years of age and over and of the long-term disabled. The HI program is financed primarily by payroll taxes, with the taxes paid by current workers used to pay benefits to current beneficiaries. However, the HI program maintains a trust fund that provides a small reserve against fluctuations. This type of financing is generally known as pay-as-you-go financing. By contrast, the SMI program is financed on an accrual basis with a contingency margin. This means that the SMI trust fund should always be somewhat greater than the claims that have been incurred by enrollees but not yet paid by the program. (ABSTRACT TRUNCATED AT 250 WORDS)</p><p>authors: N/A</p><p>issue_mesh: Annual Reports : Organization and Administration : Actuarial Analysis : Comparative Study : Medicare/organization &#x26; administration : United States</p><p>issue_number: 2</p><p>ntis_number: PB84-185321</p><p>page_range: 1-10</p><p>primary_author: N/A, N/A</p><p>title: Summary of the 1983 annual reports of the Medicare Board of Trustees.</p><p>volume: 5</p><p>year_period: 1983 Winter</p>]]></description></item><item><title>Chronic Conditions: Results of the Medicare Healt Outcomes Survey, 1998-2000</title><pubDate>Mon, 04 Nov 2019 02:27:43 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191783</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191783</guid><description><![CDATA[<p>page_range: 75-91</p><p>primary_author: N/A, N/A</p><p>title: Chronic Conditions: Results of the Medicare Healt Outcomes Survey, 1998-2000</p><p>volume: 25</p><p>year_period: 2004 Summer</p>]]></description></item><item><title>Medicaid's complex goals: Challenges for managed care and behavioral health.</title><pubDate>Mon, 04 Nov 2019 02:27:43 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191666</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191666</guid><description><![CDATA[<p>page_range: 85-101</p><p>primary_author: Gold, Marsha</p><p>title: Medicaid's complex goals: Challenges for managed care and behavioral health.</p><p>volume: 22</p><p>year_period: 2000 Winter</p>]]></description></item><item><title>Characteristics of High Staff Intensive Medicare Psychiatric Inpatients</title><pubDate>Mon, 04 Nov 2019 02:27:43 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191795</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191795</guid><description><![CDATA[<p>page_range: 103-117</p><p>primary_author: Cromwell, Jerry</p><p>title: Characteristics of High Staff Intensive Medicare Psychiatric Inpatients</p><p>volume: 26</p><p>year_period: 2004 Fall</p>]]></description></item><item><title>Reconciling medical expenditure estimates from the MEPS and the NHA, 1996.</title><pubDate>Mon, 04 Nov 2019 02:27:43 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191706</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191706</guid><description><![CDATA[<p>page_range: 161-178</p><p>primary_author: Selden, Thomas M</p><p>title: Reconciling medical expenditure estimates from the MEPS and the NHA, 1996.</p><p>volume: 23</p><p>year_period: 2001 Fall</p>]]></description></item><item><title>Children's Mental Health Services in fee-for-Service Medicaid</title><pubDate>Mon, 04 Nov 2019 02:27:43 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191789</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191789</guid><description><![CDATA[<p>page_range: 5-22</p><p>primary_author: Larson, Mary Jo</p><p>title: Children's Mental Health Services in fee-for-Service Medicaid</p><p>volume: 26</p><p>year_period: 2004 Fall</p>]]></description></item><item><title>Bed availability and hospital utilization: estimates of the "Roemer effect".</title><pubDate>Mon, 04 Nov 2019 02:27:43 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191849</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191849</guid><description><![CDATA[<p>abstract: Roemer's Law, the notion that an increase in the number of hospital beds per capita increases hospital utilization rates, is an important underpinning of efforts to control hospital construction through health planning. Attempts to measure the magnitude of the effect have yielded results ranging from no effect to a one-to-one relationship. The present study, by restricting its inquiry to Medicare patients and using a unique data base, avoids many of the shortcomings of earlier studies. This study concludes that an increase of 10 percent in hospital bed per capita would increase hospital utilization by Medicare enrollees by about 4 percent.</p><p>authors: Koretz, Daniel M</p><p>issue_mesh: Hospital Bed Capacity : Hospital Planning : Hospitals/utilization : Medicare/utilization : Statistics : United States</p><p>issue_number: 1</p><p>ntis_number: PB84-125715</p><p>page_range: 87-92</p><p>primary_author: Ginsburg, Paul B</p><p>title: Bed availability and hospital utilization: estimates of the "Roemer effect".</p><p>volume: 5</p><p>year_period: 1983 Fall</p>]]></description></item><item><title>Choosing to Convert to Critical Access Hospital Status</title><pubDate>Mon, 04 Nov 2019 02:27:42 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191765</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191765</guid><description><![CDATA[<p>page_range: 115-132</p><p>primary_author: Dalton, Kathleen</p><p>title: Choosing to Convert to Critical Access Hospital Status</p><p>volume: 25</p><p>year_period: 2003 Fall</p>]]></description></item><item><title>Estimation of Non-Response Bias in the Medicare FFS HOS</title><pubDate>Mon, 04 Nov 2019 02:27:42 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191780</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191780</guid><description><![CDATA[<p>page_range: 27-41</p><p>primary_author: McCall, Nancy</p><p>title: Estimation of Non-Response Bias in the Medicare FFS HOS</p><p>volume: 25</p><p>year_period: 2004 Summer</p>]]></description></item><item><title>Union activity in hospitals: past, present, and future.</title><pubDate>Mon, 04 Nov 2019 02:27:42 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191815</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191815</guid><description><![CDATA[<p>abstract: Between 1970 and 1980, the percentage of hospitals with one or more collective bargaining contracts increased from 15.7 percent to 27.4 percent. A substantial amount of variation exists in the extent of unionism on the basis of hospital ownership, bed size, and location. Employees are more likely to organize when hospitals in the State are regulated by a mandatory rate-setting program. Unions raise hospital employee's wages--a modal estimate for RNs is about 6 percent; the corresponding figure for nonprofessional employees is about 10 percent. Growth of union activity in hospitals has generally not been a major contributor to hospital wage inflation, and less than 10 percent of the increase in real (relative to the Consumer Price Index) spending for hospital care that occurred during the 1970s can be attributed to union growth. We project that between 45 and 50 percent of all hospitals will have at least one union by 1990.</p><p>authors: Sloan, Frank A; Steinwald, Bruce</p><p>issue_mesh: Labor Unions : Collective Bargaining/trends : Comparative Study : Personnel Administration, Hospital/trends : Salaries and Fringe Benefits/trends : Support, U.S. Gov't, P.H.S. : United States</p><p>issue_number: 4</p><p>ntis_number: PB82-219213</p><p>page_range: 1-14</p><p>primary_author: Becker, Edmund R</p><p>title: Union activity in hospitals: past, present, and future.</p><p>volume: 3</p><p>year_period: 1982 Jun</p>]]></description></item><item><title>Reporting of Drug Expenditures in the MCBS</title><pubDate>Mon, 04 Nov 2019 02:27:42 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191768</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191768</guid><description><![CDATA[<p>page_range: 23-36</p><p>primary_author: Poisal, John</p><p>title: Reporting of Drug Expenditures in the MCBS</p><p>volume: 25</p><p>year_period: 2003 Winter</p>]]></description></item><item><title>National health expenditures, 1981.</title><pubDate>Mon, 04 Nov 2019 02:27:42 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191820</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191820</guid><description><![CDATA[<p>abstract: The United States spent an estimated $287 billion for health care in 1981 (Figure 1), an amount equal to 9.8 percent of the Gross National Product (GNP). Highlights of the figures that underly this estimate include the following: Health care expenditures continued to grow at a rapid rate in 1981, at a time when the economy as a whole exhibited sluggish growth. The 9.8 percent share of the GNP was a dramatic increase from the 8.9 percent share seen just two years earlier. Health care expenditures amounted to $1,225 per person in 1981 (Table 1). Of that amount, $524, or 42.7 percent, came from public funds. Hospital care accounted for 41.2 percent of total health care spending in 1981 (Table 2). These expenditures increased 17.5 percent from 1980, to a level of $118 billion. Spending for the services of physicians increased 16.9 percent to $55 billion--19.1 percent of all health care spending. Public sources provided 42.7 percent of the money spent on health in 1981, including Federal payments of $84 billion and $39 billion in State and local government funds (Table 3). All third parties combined--private health insurers, governments, private charities, and industry--financed 67.9 percent of the $255 billion in personal health care in 1981 (Table 4), covering 89.2 percent of hospital care services, 62.1 percent of physicians' services, and 41.3 percent of the remainder (Table 5). Direct patient payments for health care reached $82 billion in 1981, accounting for 32.1 percent of all personal health care expenses (Table 6). Consumers and their employers paid another $73 billion in premiums to private health insurers, $67 billion of which was returned in the form of benefits. Outlays for health care benefits by the Medicare and Medicaid programs totaled $73 billion, including $42 billion for hospital care. The two programs combined paid for 28.6 percent of all personal health care in the nation (Table 7).</p><p>authors: Gibson, Robert M</p><p>issue_mesh: Economics, Hospital/trends : Financing, Organized/trends : Health Expenditures/trends : United States</p><p>issue_number: 1</p><p>ntis_number: PB83-104414</p><p>page_range: 1-36</p><p>primary_author: Waldo, Daniel R</p><p>title: National health expenditures, 1981.</p><p>volume: 4</p><p>year_period: 1982 Sep</p>]]></description></item><item><title>Medicare Calibration of the Clinically Detailed Risk Information System for Cost</title><pubDate>Mon, 04 Nov 2019 02:27:42 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191760</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191760</guid><description><![CDATA[<p>page_range: 37-54</p><p>primary_author: Kapur, Kanika</p><p>title: Medicare Calibration of the Clinically Detailed Risk Information System for Cost</p><p>volume: 25</p><p>year_period: 2003 Fall</p>]]></description></item><item><title>Consumers' knowledge about their health insurance coverage.</title><pubDate>Mon, 04 Nov 2019 02:27:42 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191847</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191847</guid><description><![CDATA[<p>abstract: This paper describes how much families know about their health insurance coverage and investigates whether consumer education and simplified benefit structures would improve knowledge. Families' perceptions about their insurance benefits were measured in two household surveys administered in six sites. Knowledge was assessed by comparing families' responses with policy data collected from the carrier. The vast majority of families understand insurance policies that specify one or two parameters in their benefit provisions. However, more complex payment structures are not well understood. Increased exposure to information in the plans leads to increased knowledge which suggests that education programs could improve the general level of knowledge. We conclude that if market strategies for allocating medical resources are pursued, simplifying insurance benefit structures and educating consumers about their insurance benefits would aid consumers in making more informed economic choices about medical care.</p><p>authors: N/A</p><p>issue_mesh: Awareness : Cognition : Insurance Benefits : Consumer Participation/economics : Insurance, Health : Methods : Questionnaires : Support, U.S. Gov't, Non-P.H.S. : United States</p><p>issue_number: 1</p><p>ntis_number: PB84-125715</p><p>page_range: 65-80</p><p>primary_author: Marquis, M Susan</p><p>title: Consumers' knowledge about their health insurance coverage.</p><p>volume: 5</p><p>year_period: 1983 Fall</p>]]></description></item><item><title>Racial Disparities in Prescription Drug Use Among Dually Eligible Beneficiaries</title><pubDate>Mon, 04 Nov 2019 02:27:42 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191770</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191770</guid><description><![CDATA[<p>page_range: 77-90</p><p>primary_author: Schore, Jennifer</p><p>title: Racial Disparities in Prescription Drug Use Among Dually Eligible Beneficiaries</p><p>volume: 25</p><p>year_period: 2003 Winter</p>]]></description></item><item><title>Utilization of Medicare services by beneficiaries having partial Medicare coverage.</title><pubDate>Mon, 04 Nov 2019 02:27:42 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191855</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191855</guid><description><![CDATA[<p>abstract: With the rapid increases in Medicare expenditures, policymakers are constantly reevaluating the use of and the need for services provided. One approach to better understand these issues is to identify major subgroups of the Medicare population for more detailed evaluation. A disaggregation of the data can pinpoint critical high expenditure areas for further study and may suggest potential cost containment strategies. With funding from the Health Care Financing Administration (HCFA), a series of investigations were designed to study utilization of services by particular types of Medicare beneficiaries. These include: Those who are continuously enrolled in the program over time. Those who died. Those who recently joined Medicare. Those who have one part of Medicare without the other part. This article discusses findings concerning beneficiaries who have only partial Medicare coverage (such as those who are enrolled under one part of Medicare without the other part).</p><p>authors: N/A</p><p>issue_mesh: Analysis of Variance : Eligibility Determination/economics : Health Services Needs and Demand/economics : Health Services Research/economics : Medicare/utilization : Support, U.S. Gov't, P.H.S. : United States</p><p>issue_number: 2</p><p>ntis_number: PB84-185321</p><p>page_range: 35-40</p><p>primary_author: McCall, Nelda</p><p>title: Utilization of Medicare services by beneficiaries having partial Medicare coverage.</p><p>volume: 5</p><p>year_period: 1983 Winter</p>]]></description></item><item><title>A statistical analysis of the Medicare hospital routine nursing salary cost differential.</title><pubDate>Mon, 04 Nov 2019 02:27:42 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191846</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191846</guid><description><![CDATA[<p>abstract: From July 1971 (but effective retroactively to July 1, 1969) to October 1981, Medicare hospital reimbursement methods assumed that patients in the qualifying categories of the aged, pediatric, maternal, and kidney transplant cases consumed 8.5 percent more routine nursing resources than patients outside these categories. Consequently, the Medicare program paid this nursing differential to hospitals for all its hospitalized beneficiaries in these categories. The purpose of this study is to investigate whether hospitals with more qualifying Medicare patients do, in fact, have higher per diem routine nursing salary costs. This study tests this hypothesis while attempting to hold constant the influences of other factors such as local area wages, hospital size, occupancy rate, type of control, and geographic region. Using 1979 data from over 4,500 hospitals, and 1977, 1978, and 1979 data from a sample of 1200 hospitals, this study looks at the relationship between per diem hospital routine nursing salary costs and the proportion of qualifying Medicare routine patient days in two models. Model I incorporates the framework of the Section 223 routine cost limits and Model II incorporates a comprehensive set of variables representing the hospitals' production and output characteristics. The evidence from this study provides little empirical basis to support the existence of a strong or sizable relationship and, hence, does not support payment of the Medicare routine nursing salary cost differential.</p><p>authors: N/A</p><p>issue_mesh: Salaries and Fringe Benefits : Costs and Cost Analysis : Medicare/economics : Nursing Service, Hospital/economics : Support, U.S. Gov't, Non-P.H.S. : United States</p><p>issue_number: 1</p><p>ntis_number: PB84-125715</p><p>page_range: 45-64</p><p>primary_author: Fitzmaurice, J Michael</p><p>title: A statistical analysis of the Medicare hospital routine nursing salary cost differential.</p><p>volume: 5</p><p>year_period: 1983 Fall</p>]]></description></item><item><title>Abstracts of state legislated hospital cost-containment programs.</title><pubDate>Mon, 04 Nov 2019 02:27:42 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191830</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191830</guid><description><![CDATA[<p>abstract: This report summarizes State legislated efforts to control rising hospital costs and the status of these efforts in May 1982. The abstract for each of 17 State programs summarizes key legislative features and operating aspects. The States included in this report are: Arizona, California, Connecticut, Florida, Illinois, Maine, Maryland, Massachusetts, Minnesota, New Jersey, New York, Oregon, Rhode Island, Virginia, Washington, West Virginia, and Wisconsin, The abstracts focus on programs requiring the disclosure, review, or legislation of hospital rates and budgets.</p><p>authors: Hupfer, Michael; Mason, Cynthia; Rogler, Diane</p><p>issue_mesh: Legislation, Hospital : Budgets/legislation &#x26; jurisprudence : Cost Control/legislation &#x26; jurisprudence : Financial Management/legislation &#x26; jurisprudence : Inflation, Economic : Prospective Payment System/legislation &#x26; jurisprudence : Rate Setting and Review/legislation &#x26; jurisprudence : Reimbursement Mechanisms/legislation &#x26; jurisprudence : United States</p><p>issue_number: 2</p><p>ntis_number: PB83-149815</p><p>page_range: 129-158</p><p>primary_author: Esposito, Alfonso</p><p>title: Abstracts of state legislated hospital cost-containment programs.</p><p>volume: 4</p><p>year_period: 1982 Dec</p>]]></description></item><item><title>Health insurance and health policy in the Federal Republic of Germany.</title><pubDate>Mon, 04 Nov 2019 02:27:42 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191804</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191804</guid><description><![CDATA[<p>abstract: This paper presents a structured survey of the West German health care and health insurance system. The West German health insurance system is very comprehensive and generous. The scheme provides full coverage for all medically necessary services, including ambulatory and inpatient care, prescription drugs, dental care, medical appliances and even prolonged rehabilitation in the so called Kurorten (localities with health spas). Typically, patients do not bear any copayment at the point of service, or only very modest ones. Physicians are paid on a fee-for-service basis (according to negotiated fee schedules), hospitals are reimbursed on the basis of prospectively negotiated per diems, and the suppliers of drugs and appliances are reimbursed at what is referred to as "market prices" (that is, at prices set by suppliers with only mild indirect control from the public sector or third-party payors). This extraordinarily liberal insurance system causes West Germany to devote no greater a proportion of their Gross National Product (GNP) to health care than does the United States. Using the American definition of "national health care expenditures," both nations currently devote about 9.4 percent of their GNP to health care.</p><p>authors: N/A</p><p>issue_mesh: Comparative Study : Germany, West : Health Expenditures/trends : Insurance, Health/utilization : National Health Programs/organization &#x26; administration : Support, U.S. Gov't, P.H.S.</p><p>issue_number: 2</p><p>ntis_number: PB82-188426</p><p>page_range: 1-14</p><p>primary_author: Reinhardt, Uwe E</p><p>title: Health insurance and health policy in the Federal Republic of Germany.</p><p>volume: 3</p><p>year_period: 1981 Dec</p>]]></description></item><item><title>Prescription Drug Benefits: Cost Management Issues for Medicare</title><pubDate>Mon, 04 Nov 2019 02:27:42 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191767</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191767</guid><description><![CDATA[<p>page_range: 7-21</p><p>primary_author: Fox, Peter</p><p>title: Prescription Drug Benefits: Cost Management Issues for Medicare</p><p>volume: 25</p><p>year_period: 2003 Winter</p>]]></description></item><item><title>Developing Dialysis Facility-Specific Performance Measures for Public Reporting</title><pubDate>Mon, 04 Nov 2019 02:27:42 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191716</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191716</guid><description><![CDATA[<p>page_range: 37-50</p><p>primary_author: Frederick, Pamela</p><p>title: Developing Dialysis Facility-Specific Performance Measures for Public Reporting</p><p>volume: 23</p><p>year_period: 2002 Summer</p>]]></description></item><item><title>Factors influencing mammography use among women in Medicare managed care.</title><pubDate>Mon, 04 Nov 2019 02:27:42 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191686</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191686</guid><description><![CDATA[<p>page_range: 49-61</p><p>primary_author: Barr, Judith K</p><p>title: Factors influencing mammography use among women in Medicare managed care.</p><p>volume: 22</p><p>year_period: 2001 Summer</p>]]></description></item><item><title>Psychometric Evaluation of the SF-36 Health Survey in Medicare Managed Care</title><pubDate>Mon, 04 Nov 2019 02:27:42 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191779</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191779</guid><description><![CDATA[<p>page_range: 5-25</p><p>primary_author: Gandek, Barbara</p><p>title: Psychometric Evaluation of the SF-36 Health Survey in Medicare Managed Care</p><p>volume: 25</p><p>year_period: 2004 Summer</p>]]></description></item><item><title>Hospitals and health maintenance organizations: an analysis of the Minneapolis-St. Paul experience.</title><pubDate>Mon, 04 Nov 2019 02:27:40 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191832</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191832</guid><description><![CDATA[<p>abstract: Minneapolis-St. Paul is recognized as a prime example of health care competition. Policymakers and others have been asked to look to the Twin Cities as a model upon which to base new competitive initiatives in the health care sector. Yet little is known about the impact of Health Maintenance Organizations (HMOs) on other health care providers. This study examines the effects of the area's seven health maintenance organizations on the local hospital community. Three questions are addressed. First, is the situation in the Twin Cities unique? A comparison of case study findings and the available literature together with hospital data from similarly HMO-penetrated markets suggests that the Twin Cities' hospital market is indeed different. Second, what is the nature of hospital-HMO interaction? The flexibility of contracting apparently allows hospitals to affiliate successfully with an HMO under a variety of service and reimbursement agreements. Third, what effect has HMO activity had on community-wide utilization? While HMO enrollees clearly use fewer hospital days and the trend in the community is toward fewer days, attributing the change to HMOs is difficult. A large portion of the differences between HMO and community-wide utilization levels is attributable to differences in population.</p><p>authors: Ashby, Cynthia S; Gibson, Geoffrey</p><p>issue_mesh: Organizational Affiliation : Comparative Study : Economic Competition/trends : Economics/trends : Group Practice, Prepaid/organization &#x26; administration : Health Maintenance Organizations/organization &#x26; administration : Hospitals/utilization : Interinstitutional Relations : Minnesota : Socioeconomic Factors</p><p>issue_number: 3</p><p>ntis_number: PB83-175620</p><p>page_range: 59-69</p><p>primary_author: Morrisey, Michael A</p><p>title: Hospitals and health maintenance organizations: an analysis of the Minneapolis-St. Paul experience.</p><p>volume: 4</p><p>year_period: 1983 Mar</p>]]></description></item><item><title>Symptoms of Depression Among Aged Medicare Enrollees: 2002</title><pubDate>Mon, 04 Nov 2019 02:27:40 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191797</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191797</guid><description><![CDATA[<p>page_range: 143-155</p><p>primary_author: Waldo, Daniel</p><p>title: Symptoms of Depression Among Aged Medicare Enrollees: 2002</p><p>volume: 26</p><p>year_period: 2004 Fall</p>]]></description></item><item><title>Drug Coverage, Utilization, and Spending by Medicare Beneficiaries with Heart Disease</title><pubDate>Mon, 04 Nov 2019 02:27:40 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191746</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191746</guid><description><![CDATA[<p>page_range: 139-157</p><p>primary_author: Sharma, Ravi</p><p>title: Drug Coverage, Utilization, and Spending by Medicare Beneficiaries with Heart Disease</p><p>volume: 24</p><p>year_period: 2003 Spring</p>]]></description></item><item><title>Health Status of Dually Eligible Beneficiaries in Managed Care Plans</title><pubDate>Mon, 04 Nov 2019 02:27:40 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191782</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191782</guid><description><![CDATA[<p>page_range: 59-74</p><p>primary_author: Lied, Terry</p><p>title: Health Status of Dually Eligible Beneficiaries in Managed Care Plans</p><p>volume: 25</p><p>year_period: 2004 Summer</p>]]></description></item><item><title>Home and community-based services waivers.</title><pubDate>Mon, 04 Nov 2019 02:27:40 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191656</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191656</guid><description><![CDATA[<p>abstract: The history and current status of the Medicaid Home and Community-Based Services Waiver Program are presented. This article discusses the States' role in developing and implementing creative alternatives to institutional care for individuals who are Medicaid eligible. Also described are services that may be provided under the waiver program and populations served.</p><p>authors: Guy, Mary R</p><p>issue_mesh: Community Health Services : Home Care Services : Medicaid : State Government : United States : United States Health Care Financing Administration</p><p>issue_number: 1</p><p>ntis_number: PB2001-105913</p><p>page_range: 123-125</p><p>primary_author: Duckett, Mary J</p><p>title: Home and community-based services waivers.</p><p>volume: 22</p><p>year_period: 2000 Fall</p>]]></description></item><item><title>Medicare Interim Payment System's Impact on Medicare Home Health Utilization</title><pubDate>Mon, 04 Nov 2019 02:27:40 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191763</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191763</guid><description><![CDATA[<p>page_range: 81-97</p><p>primary_author: Liu, Korbin</p><p>title: Medicare Interim Payment System's Impact on Medicare Home Health Utilization</p><p>volume: 25</p><p>year_period: 2003 Fall</p>]]></description></item><item><title>Pre-enrollment reimbursement patterns of Medicare beneficiaries enrolled in "at-risk" HMOs.</title><pubDate>Mon, 04 Nov 2019 02:27:40 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191822</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191822</guid><description><![CDATA[<p>abstract: The Health Care Financing Administration (HCFA) has initiated several demonstration projects to encourage HMOs to participate in the Medicare program under a risk mechanism. These demonstrations are designed to test innovative marketing techniques, benefit packages, and reimbursement levels. HCFA's current method for prospective payments to HMOs is based on the Adjusted Average Per Capita Cost (AAPCC). An important issue in prospective reimbursement is the extent to which the AAPCC adequately reflects the risk factors which arise out of the selection process of Medicare beneficiaries into HMOs. This study examines the pre-enrollment reimbursement experience of Medicare beneficiaries who enrolled in the demonstration HMOs to determine whether or not a non-random selection process took place. The results of this study suggest that the AAPCC may not be an adequate mechanism for setting prospective reimbursement rates. The Marshfield results further suggest that the type of HMO may have an influence on the selection process among Medicare beneficiaries. If Medicare beneficiaries do not have to change providers to join an HMO, as in an IPA model or a staff model which includes most of the providers in an area, the selection process may be more likely to result in an unbiased risk group.</p><p>authors: Prihoda, Ronald</p><p>issue_mesh: Costs and Cost Analysis : Health Maintenance Organizations/economics : Massachusetts : Medicare/utilization : Oregon : Pilot Projects : Prospective Payment System/methods : Reimbursement Mechanisms/methods : Risk : Wisconsin</p><p>issue_number: 1</p><p>ntis_number: PB83-104414</p><p>page_range: 55-73</p><p>primary_author: Eggers, Paul W</p><p>title: Pre-enrollment reimbursement patterns of Medicare beneficiaries enrolled in "at-risk" HMOs.</p><p>volume: 4</p><p>year_period: 1982 Sep</p>]]></description></item><item><title>Trends in Medicaid Prescribed Drug Expenditures and Utilizaiton</title><pubDate>Mon, 04 Nov 2019 02:27:40 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191777</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191777</guid><description><![CDATA[<p>page_range: 69-78</p><p>primary_author: Tepper, Carl</p><p>title: Trends in Medicaid Prescribed Drug Expenditures and Utilizaiton</p><p>volume: 25</p><p>year_period: 2004 Spring</p>]]></description></item><item><title>Comparing Medicare Beneficiaries, by type of Post-Acute Care Received: 1999</title><pubDate>Mon, 04 Nov 2019 02:27:40 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191736</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191736</guid><description><![CDATA[<p>page_range: 137-142</p><p>primary_author: Shatto, Andrew</p><p>title: Comparing Medicare Beneficiaries, by type of Post-Acute Care Received: 1999</p><p>volume: 24</p><p>year_period: 2002 Winter</p>]]></description></item><item><title>Personal health care expenditures by state, selected years 1966-1978.</title><pubDate>Mon, 04 Nov 2019 02:27:40 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191825</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191825</guid><description><![CDATA[<p>abstract: In 1966, spending for personal health care in the U.S. was $39 billion. By 1978, these expenditures had grown to $166 billion. Among regions and states, different patterns and levels of spending emerged, along with different rates of growth. Some of the highlights from the accompanying report which pinpoint personal health care spending differences among regions and states are listed below. In 1978, $745 per person was spent for personal health care services within the U.S. Massachusetts led the nation in spending with $935 per person. The lowest spending for personal health--$521 per capita--occurred in South Carolina. Expenditures for hospital care ranged from a high of $490 per capita in Massachusetts to a low of $197 per capita in Idaho, with the U.S. expenditure level at $337 per person.</p><p>authors: N/A</p><p>issue_mesh: Demography : Health Expenditures/trends : Hospitals/utilization : Income : Nursing Homes/utilization : Personal Health Services/utilization : Physicians/utilization : United States</p><p>issue_number: 2</p><p>ntis_number: PB83-149815</p><p>page_range: 1-46</p><p>primary_author: Levit, Katharine R</p><p>title: Personal health care expenditures by state, selected years 1966-1978.</p><p>volume: 4</p><p>year_period: 1982 Dec</p>]]></description></item><item><title>A data-driven approach to improving the care of in-center hemodialysis patients.</title><pubDate>Mon, 04 Nov 2019 02:27:40 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191378</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191378</guid><description><![CDATA[<p>abstract: Health care providers, patients, the end stage renal disease (ESRD) networks, and HCFA have developed the ESRD Health Care Quality Improvement Program (HCQIP) in an effort to assess and improve care provided to ESRD patients. Currently, the ESRD HCQIP focuses on collecting information on quality indicators (QIs) for treatment of anemia, delivery of adequate dialysis, nutritional status, and blood pressure control for adult in-center hemodialysis patients. QIs were measured in a national probability sample of ESRD patients, and interventions and evaluations of the interventions are beginning. The ESRD HCQIP illustrates a way to mobilize the strengths of the public and private sectors to achieve improved care for special populations.</p><p>authors: Ballard, David J; Frederick, Pamela R; Hayes, Risa P; Helgerson, Steven D; McMullan, Michael</p><p>issue_mesh: Adult : Anemia/complications/therapy : Health Services Research/methods : Hemodialysis Units, Hospital/standards : Human : Kidney Failure, Chronic/complications/therapy : Program Evaluation : Quality Assurance, Health Care/organization &#x26; administration : Quality of Health Care/standards : Reproducibility of Results : Support, Non-U.S. Gov't : United States Health Care Financing Administration : United States/epidemiology</p><p>issue_number: 4</p><p>ntis_number: PB99-106445</p><p>page_range: 129-140</p><p>primary_author: McClellan, William M</p><p>title: A data-driven approach to improving the care of in-center hemodialysis patients.</p><p>volume: 16</p><p>year_period: 1995 Summer</p>]]></description></item><item><title>Open Access to Innovative Drugs: Treatment Susbtititions or Treatment Expansion?</title><pubDate>Mon, 04 Nov 2019 02:27:40 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191775</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191775</guid><description><![CDATA[<p>page_range: 35-53</p><p>primary_author: McCombs, Jeffrey</p><p>title: Open Access to Innovative Drugs: Treatment Susbtititions or Treatment Expansion?</p><p>volume: 25</p><p>year_period: 2004 Spring</p>]]></description></item><item><title>Beneficiaries' perceptions of new Medicare health plan choice print materials.</title><pubDate>Mon, 04 Nov 2019 02:27:40 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191696</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191696</guid><description><![CDATA[<p>page_range: 21-35</p><p>primary_author: Harris-Kojetin, Lauren D</p><p>title: Beneficiaries' perceptions of new Medicare health plan choice print materials.</p><p>volume: 23</p><p>year_period: 2001 Fall</p>]]></description></item><item><title>Use and costs under the Iowa capitation drug program.</title><pubDate>Mon, 04 Nov 2019 02:27:40 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191802</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191802</guid><description><![CDATA[<p>abstract: This article evaluates changes in the use of drug services and the corresponding costs when the conventional fee-for-service system for reimbursement of pharmacists under medicaid is replaced by a capitation system. The fee-for-service system usually covers ingredient costs plus a fixed professional dispensing fee. The capitation system provided a cash payment (which varied by aid category and season of the year) per Medicaid eligible the first of each month. We examined drug use and costs in two experimental rural counties during a 1-year preperiod in which the fee-for-service form of reimbursement was employed, as well as a 2-year postperiod in which the capitation system was used. We compared the results with use and cost patients in two other rural counties which remained on the fee-for-service system during the same 3-year period. Drug use was similar among control and experimental counties with the exception of nursing home patients; use in this category decreased under capitation and increased under fee-for-service. Using three measures of drug cost: 1) average cost of a day's drug therapy; 2) average drug costs per recipient; and 3) average Medicaid expenditures for drug services per recipient, we observed significant savings under the capitation reimbursement system as compared to the fee-for-service system. We attributed savings under capitation to shifts in prescribing and dispensing behavior, as well as changes in use by nursing home patients. Based upon these findings, the total savings resulting from implementing capitation would be approximately 16 percent compared to fee-for-service reimbursement.</p><p>authors: Burmeister, Leon F; Fisher, Wayne P; Helling, Dennis K; Lipson, David P; Norwood, G Joseph</p><p>issue_mesh: Capitation Fee : Fees and Charges : Insurance, Pharmaceutical Services/economics : Iowa : Medicaid/utilization</p><p>issue_number: 1</p><p>ntis_number: PB82-130170</p><p>page_range: 127-136</p><p>primary_author: Yesalis 3d, Charles E</p><p>title: Use and costs under the Iowa capitation drug program.</p><p>volume: 3</p><p>year_period: 1981 Sep</p>]]></description></item><item><title>Favorable selection in the Medicare+Choice program: New evidence</title><pubDate>Mon, 04 Nov 2019 02:27:40 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191631</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191631</guid><description><![CDATA[<p>page_range: 127-134</p><p>primary_author: Greenwald, Leslie M</p><p>title: Favorable selection in the Medicare+Choice program: New evidence</p><p>volume: 21</p><p>year_period: 2000 Spring</p>]]></description></item><item><title>Demonstrations of alternative delivery systems under Medicare and Medicaid.</title><pubDate>Mon, 04 Nov 2019 02:27:40 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191809</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191809</guid><description><![CDATA[<p>abstract: The current Administration supports competition as one method of helping to contain escalating costs. Proponents of competition claim many advantages to its implementation, but their claims have yet to be widely tested. Over the past several years, however, the Health Care Financing Administration has supported a number of Medicare and Medicaid demonstrations to yield information on plan participation, marketing, and reimbursement under alternative delivery systems. Much of these data are applicable to the competitive plans being considered by the Administration and Congress. This paper discusses recent findings from these projects.</p><p>authors: Trieger, Sidney</p><p>issue_mesh: Delivery of Health Care/organization &#x26; administration : Health Maintenance Organizations/utilization : Marketing of Health Services : Medicaid/utilization : Medicare/utilization : Pilot Projects : United States</p><p>issue_number: 3</p><p>ntis_number: PB82-203878</p><p>page_range: 1-12</p><p>primary_author: Galblum, Trudi W</p><p>title: Demonstrations of alternative delivery systems under Medicare and Medicaid.</p><p>volume: 3</p><p>year_period: 1982 Mar</p>]]></description></item><item><title>The nursing home population: different perspectives and implications for policy.</title><pubDate>Mon, 04 Nov 2019 02:27:40 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191805</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191805</guid><description><![CDATA[<p>abstract: Long-term care institutions are used by residential patients who stay for many years and patients with specific ailments who stay for relatively short periods. The presence of short-stay patients is not adequately recorded by cross-sectional surveys which have been used to measure nursing home use. To obtain a better understanding about the mix of long-stay and short-stay patients, we created a hypothetical population of all users of nursing homes in the United States for a 12-month period. Descriptive statistics are presented on this annual population, which we derived empirically from the 1977 National Nursing Home Survey. We found that an estimated 2.4 million individuals used nursing homes at some time during 1976.</p><p>authors: Palesch, Yuko</p><p>issue_mesh: Aged : Analysis of Variance : Diagnosis-Related Groups : Human : Length of Stay/trends : Nursing Homes/utilization : United States</p><p>issue_number: 2</p><p>ntis_number: PB82-188426</p><p>page_range: 15-23</p><p>primary_author: Liu, Korbin</p><p>title: The nursing home population: different perspectives and implications for policy.</p><p>volume: 3</p><p>year_period: 1981 Dec</p>]]></description></item><item><title>The use of intensive care: a comparison of a university and community hospital.</title><pubDate>Mon, 04 Nov 2019 02:27:40 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191807</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191807</guid><description><![CDATA[<p>abstract: We compared 223 consecutive intensive care unit (ICU) admissions to a community hospital (CH) with 613 such admissions at a university hospital (UH) using a new clinical scale aimed at quantifying severity of illness. Both ICU's had similar technical resources and treatment capabilities. At the CH, however, patients were more often admitted for monitoring rather than for treatment of UH admissions had a substantially greater acute severity of illness (p less than .001) than CH patients in most diagnostic categories. These findings suggest that use of the ICU was substantially different in the two hospitals, with the CH admitting many more stable patients. This study also suggests that evaluation of ICU use is improved by quantitative measurement of severity of illness.</p><p>authors: Knaus, William A; Wagner, Douglas P</p><p>issue_mesh: Costs and Cost Analysis : Diagnosis-Related Groups : Comparative Study : District of Columbia : Hospital Bed Capacity, 300 to 499 : Hospital Bed Capacity, 500 and over : Hospitals, Community/utilization : Hospitals, Teaching/utilization : Hospitals, University/utilization : Intensive Care Units/utilization : Mid-Atlantic Region : Regression Analysis : Support, U.S. Gov't, P.H.S.</p><p>issue_number: 2</p><p>ntis_number: PB82-188426</p><p>page_range: 49-64</p><p>primary_author: Draper, Elizabeth A</p><p>title: The use of intensive care: a comparison of a university and community hospital.</p><p>volume: 3</p><p>year_period: 1981 Dec</p>]]></description></item><item><title>Performance Assessment in Community Mental Health Care and At-Risk Populations</title><pubDate>Mon, 04 Nov 2019 02:27:40 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191793</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191793</guid><description><![CDATA[<p>page_range: 75-84</p><p>primary_author: Holmes, Ann</p><p>title: Performance Assessment in Community Mental Health Care and At-Risk Populations</p><p>volume: 26</p><p>year_period: 2004 Fall</p>]]></description></item><item><title>Approaches to eliminating sociocultural disparities in health</title><pubDate>Mon, 04 Nov 2019 02:27:40 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191641</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191641</guid><description><![CDATA[<p>page_range: 57-74</p><p>primary_author: Horowitz, Carol R</p><p>title: Approaches to eliminating sociocultural disparities in health</p><p>volume: 21</p><p>year_period: 2000 Summer</p>]]></description></item><item><title>Prescribed medicines: a comparison of FFS with HMO enrollees.</title><pubDate>Mon, 04 Nov 2019 02:27:39 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191446</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191446</guid><description><![CDATA[<p>authors: Poisal, John A</p><p>issue_mesh: Comparative Study : Drug Utilization/economics/statistics &#x26; numerical data : Fee-for-Service Plans/economics/statistics &#x26; numerical data : Financing, Personal/statistics &#x26; numerical data : Health Care Surveys : Health Maintenance Organizations/economics/statistics &#x26; numerical data : Medicare/statistics &#x26; numerical data : Prescription Fees/statistics &#x26; numerical data : United States</p><p>issue_number: 4</p><p>ntis_number: PB97-104087</p><p>page_range: 213-215</p><p>primary_author: Eppig, Franklin J</p><p>title: Prescribed medicines: a comparison of FFS with HMO enrollees.</p><p>volume: 17</p><p>year_period: 1996 Summer</p>]]></description></item><item><title>Residential care supply, nursing home licensing, and case mix in four States</title><pubDate>Mon, 04 Nov 2019 02:27:39 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191636</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191636</guid><description><![CDATA[<p>page_range: 203-229</p><p>primary_author: Swan, James H</p><p>title: Residential care supply, nursing home licensing, and case mix in four States</p><p>volume: 21</p><p>year_period: 2000 Spring</p>]]></description></item><item><title>Developing performance measures for prescription drug management.</title><pubDate>Mon, 04 Nov 2019 02:27:39 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191678</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191678</guid><description><![CDATA[<p>page_range: 71-84</p><p>primary_author: Chawla, Anita J</p><p>title: Developing performance measures for prescription drug management.</p><p>volume: 22</p><p>year_period: 2001 Spring</p>]]></description></item><item><title>Preferred provider organizations and physician fees.</title><pubDate>Mon, 04 Nov 2019 02:27:39 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191426</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191426</guid><description><![CDATA[<p>abstract: Preferred provider organizations (PPOs) represent a form of managed care in which providers agree to accept discounted fees in exchange for the expectation that their patient volume will increase or at least be maintained. Managed care plans that rely on discounted fee-for-service (FFS) payments have increased from about 10 plans in 1981 to over 700 plans in 1994. In this study, we document levels of discounts achieved by two large national insurers and discuss how the size of the discount varies by type of service and how the discounted rates relate to Medicare fees. Our results show that, despite achieving large discounts (approximately 10 20 percent) relative to their indemnity plans, the two nationwide PPOs studied here pay at rates substantially above Medicare levels.</p><p>authors: Zuckerman, Stephen</p><p>issue_mesh: Comparative Study : Fee-for-Service Plans/classification/economics : Fees, Medical : Health Care Costs/classification : Insurance Claim Review : Insurance, Health/economics : Medicare Part B/economics : Office Visits/economics : Physicians/economics : Preferred Provider Organizations/classification/economics : Relative Value Scales : Support, U.S. Gov't, Non-P.H.S. : United States</p><p>issue_number: 3</p><p>ntis_number: PB99-106510</p><p>page_range: 161-170</p><p>primary_author: Verrilli, Diana K</p><p>title: Preferred provider organizations and physician fees.</p><p>volume: 17</p><p>year_period: 1996 Spring</p>]]></description></item><item><title>State health expenditure accounts: Minnesota s perspective</title><pubDate>Mon, 04 Nov 2019 02:27:39 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191618</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191618</guid><description><![CDATA[<p>page_range: 65-83</p><p>primary_author: Blewett, Lynn A</p><p>title: State health expenditure accounts: Minnesota s perspective</p><p>volume: 21</p><p>year_period: 1999 Winter</p>]]></description></item><item><title>Medical expenditures for major diseases, 1995</title><pubDate>Mon, 04 Nov 2019 02:27:39 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191621</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191621</guid><description><![CDATA[<p>page_range: 119-164</p><p>primary_author: Hodgson, Thomas A</p><p>title: Medical expenditures for major diseases, 1995</p><p>volume: 21</p><p>year_period: 1999 Winter</p>]]></description></item><item><title>Evaluation of the ESRD Managed Care Demonstration Operations</title><pubDate>Mon, 04 Nov 2019 02:27:39 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191748</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191748</guid><description><![CDATA[<p>page_range: 7-29</p><p>primary_author: Oppenheimer, Caitlin</p><p>title: Evaluation of the ESRD Managed Care Demonstration Operations</p><p>volume: 24</p><p>year_period: 2003 Summer</p>]]></description></item><item><title>State health expenditure accounts: Purposes, priorities, and procedures</title><pubDate>Mon, 04 Nov 2019 02:27:39 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191616</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191616</guid><description><![CDATA[<p>page_range: 25-45</p><p>primary_author: Long, Stephen H</p><p>title: State health expenditure accounts: Purposes, priorities, and procedures</p><p>volume: 21</p><p>year_period: 1999 Winter</p>]]></description></item><item><title>Assessing Medicare beneficiaries' readiness to make informed health plan choices.</title><pubDate>Mon, 04 Nov 2019 02:27:39 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191701</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191701</guid><description><![CDATA[<p>page_range: 87-104</p><p>primary_author: Levesque, Deborah A</p><p>title: Assessing Medicare beneficiaries' readiness to make informed health plan choices.</p><p>volume: 23</p><p>year_period: 2001 Fall</p>]]></description></item><item><title>Limitations of and barriers to using performance measurement: Purchasers' perspective.</title><pubDate>Mon, 04 Nov 2019 02:27:39 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191676</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191676</guid><description><![CDATA[<p>page_range: 49-57</p><p>primary_author: Ginsberg, Caren</p><p>title: Limitations of and barriers to using performance measurement: Purchasers' perspective.</p><p>volume: 22</p><p>year_period: 2001 Spring</p>]]></description></item><item><title>ESRD Managed Care Demonstration: Financial Implications</title><pubDate>Mon, 04 Nov 2019 02:27:39 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191751</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191751</guid><description><![CDATA[<p>page_range: 59-75</p><p>primary_author: Dykstra, Dawn</p><p>title: ESRD Managed Care Demonstration: Financial Implications</p><p>volume: 24</p><p>year_period: 2003 Summer</p>]]></description></item><item><title>A patient-based analysis of drug disorder diagnoses in the Medicare population.</title><pubDate>Mon, 04 Nov 2019 02:27:39 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191301</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191301</guid><description><![CDATA[<p>abstract: This article utilizes the Part A Medicare provider analysis and review (MEDPAR) file for fiscal year (FY) 1987. The discharge records were organized into a patient-based record that included alcohol, drug, and mental (ADM) disorder diagnoses as well as measures of resource use. The authors find that there are substantially higher costs of health care incurred by the drug disorder diagnosed population. Those of the Medicare population diagnosed with drug disorders had longer lengths of stay (LOSs), higher hospital charges, and more discharges. Costs increased monotonically as the number of drug diagnoses increased. Overlap of mental and alcohol problems is presented for the drug disorder diagnosed population.</p><p>authors: Ingster, Lillian M</p><p>issue_mesh: Aged : Alcoholism/economics/epidemiology : Comorbidity : Data Collection : Disabled Persons/statistics &#x26; numerical data : Female : Health Services Research : Hospital Charges/statistics &#x26; numerical data : Hospital Units/economics/utilization : Human : Length of Stay/economics/statistics &#x26; numerical data : Male : Medicare Part A/statistics &#x26; numerical data/utilization : Mental Disorders/economics/epidemiology : Substance Abuse Treatment Centers/economics/utilization : Substance-Related Disorders/economics/epidemiology : United States/epidemiology</p><p>issue_number: 2</p><p>ntis_number: PB95-123469</p><p>page_range: 89-101</p><p>primary_author: Cartwright, William S</p><p>title: A patient-based analysis of drug disorder diagnoses in the Medicare population.</p><p>volume: 15</p><p>year_period: 1993 Winter</p>]]></description></item><item><title>Quality assurance for a program of comprehensive care for older persons.</title><pubDate>Mon, 04 Nov 2019 02:27:39 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191281</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191281</guid><description><![CDATA[<p>abstract: Quality assurance (QA) for comprehensive programs like the Program of All-inclusive Care for the Elderly (PACE) requires a special strategy. The assessment phase should be capable of looking across the usual subdivisions of care to recognize the contributions of various disciplines, and to focus on the effects of that care on the patient. Measures should thus include both problem-specific and patient-focused elements. The tracer technique which follows the care of specific problems provides an opportunity to look at both the process and outcomes of care. An outcomes focus which looks at patient functioning as well as condition-specific parameters can include specific sentinel events whose presence suggests untoward developments. Quality assurance implies more than assessment. It represents a commitment to act responsibly on the information obtained to improve the care rendered. It includes a strategy for proactive involvement where caregivers are prompted to consider pertinent information in a timely fashion, and a retrospective remedial approach where the data are analyzed and presented in a format that can be readily understood and which suggests next steps to improve care.</p><p>authors: Blewett, Lynn A</p><p>issue_mesh: Aged : Ambulatory Care/standards : Comprehensive Health Care/standards : Frail Elderly : Health Services for the Aged/standards : Human : Outcome and Process Assessment (Health Care)/organization &#x26; administration : Patient Advocacy/standards : Planning Techniques : Prepaid Health Plans/standards : Quality Assurance, Health Care/organization &#x26; administration : Support, Non-U.S. Gov't : Support, U.S. Gov't, Non-P.H.S. : United States</p><p>issue_number: 4</p><p>ntis_number: PB95-123485</p><p>page_range: 89-110</p><p>primary_author: Kane, Robert L</p><p>title: Quality assurance for a program of comprehensive care for older persons.</p><p>volume: 14</p><p>year_period: 1993 Summer</p>]]></description></item><item><title>U.S. Healthcare's quality-based compensation model.</title><pubDate>Mon, 04 Nov 2019 02:27:39 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191425</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191425</guid><description><![CDATA[<p>abstract: U.S. Healthcare has developed a quality-based compensation model through which its primary care physicians, hospitals, and specialists can earn additional compensation based on the quality and cost-effectiveness of the care they provide to their patients. The model clearly delineates the expectations of U.S. Healthcare, and in contrast with traditional payment models, encourages improvement in performance. In addition, the model aligns the incentives of U.S. Healthcare purchasers, participating providers, and members in order to provide high-quality, cost-effective care that maximizes patient outcomes.</p><p>authors: Harmon-Weiss, Sandra; Schlackman, Neil</p><p>issue_mesh: Capitation Fee : Cost-Benefit Analysis : Health Maintenance Organizations/economics : Hospitalization/economics : Human : Models, Economic : Outcome Assessment (Health Care) : Physician Incentive Plans/economics : Quality of Health Care/economics : Reimbursement, Incentive/economics : Specialties, Medical/economics : United States</p><p>issue_number: 3</p><p>ntis_number: PB99-106510</p><p>page_range: 143-159</p><p>primary_author: Hanchak, Nicholas A</p><p>title: U.S. Healthcare's quality-based compensation model.</p><p>volume: 17</p><p>year_period: 1996 Spring</p>]]></description></item><item><title>An analysis of utilization and access from the NHIS: 1984-92.</title><pubDate>Mon, 04 Nov 2019 02:27:39 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191405</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191405</guid><description><![CDATA[<p>abstract: While the aged as a group have better access to health care since the inception of Medicare, there are subsets of the population that are still vulnerable to large out-of-pocket expenses. The focus of this analysis is on those segments of the Medicare population which are particularly vulnerable to access problems due to their personal characteristics. In particular, using data from the National Health Interview Survey (NHIS), this article will focus on the simultaneous influence of personal characteristics, such as insurance status, income, health status, and race on the use of physician services by the elderly population.</p><p>authors: Benner, Suzanne; Park, Young; Ross, William</p><p>issue_mesh: Aged : Data Collection : Health Services Accessibility/statistics &#x26; numerical data : Health Services for the Aged/economics/utilization : Health Status : Human : Income : Insurance Benefits : Medicare/statistics &#x26; numerical data/utilization : Multivariate Analysis : Office Visits : Support, U.S. Gov't, Non-P.H.S. : United States</p><p>issue_number: 2</p><p>ntis_number: PB96-172663</p><p>page_range: 51-59</p><p>primary_author: Mentnech, Renee M</p><p>title: An analysis of utilization and access from the NHIS: 1984-92.</p><p>volume: 17</p><p>year_period: 1995 Winter</p>]]></description></item><item><title>Adjusting performance measures to ensure equitable plan comparisons.</title><pubDate>Mon, 04 Nov 2019 02:27:39 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191681</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191681</guid><description><![CDATA[<p>page_range: 109-126</p><p>primary_author: Zaslavsky, Alan M</p><p>title: Adjusting performance measures to ensure equitable plan comparisons.</p><p>volume: 22</p><p>year_period: 2001 Spring</p>]]></description></item><item><title>State health expenditure accounts: building blocks for state health spending analysis.</title><pubDate>Mon, 04 Nov 2019 02:27:39 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191399</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191399</guid><description><![CDATA[<p>abstract: The dynamics of financing health care among various levels of government and the private sector are rapidly changing; structural relationships among health care providers are also being altered. These changes are placing increased importance on State-level expenditure estimates that will be instrumental in measuring the differential impact of Federal policies and State-specific initiatives on individual States. This article presents personal health care expenditures (PHCE) for 1980-93. Statistics show wide variation in level and rate of growth of regional spending per person. These statistics also quantify differences in both the percent of health care costs in each State borne by Medicare and Medicaid and in the proportion of each State's economy devoted to the provision of health care.</p><p>authors: Cowan, Cathy A; Lazenby, Helen C; Sivarajan, Lekha; Stewart, Madie W; Stiller, Jean M; Won, Darleen K</p><p>issue_mesh: Aged : Comparative Study : Dental Health Services/economics/statistics &#x26; numerical data : Drug Costs/statistics &#x26; numerical data : Health Expenditures/statistics &#x26; numerical data : Health Maintenance Organizations/economics/statistics &#x26; numerical data : Health Policy : Home Care Services/economics/statistics &#x26; numerical data : Human : Medicaid/economics/statistics &#x26; numerical data : Medicare/economics/statistics &#x26; numerical data : Nursing Homes/economics/statistics &#x26; numerical data : Primary Health Care/economics/statistics &#x26; numerical data : State Health Plans/economics/statistics &#x26; numerical data : United States</p><p>issue_number: 1</p><p>ntis_number: PB96-139548</p><p>page_range: 201-254</p><p>primary_author: Levit, Katharine R</p><p>title: State health expenditure accounts: building blocks for state health spending analysis.</p><p>volume: 17</p><p>year_period: 1995 Fall</p>]]></description></item><item><title>Measuring quality of care under Medicare and Medicaid.</title><pubDate>Mon, 04 Nov 2019 02:27:39 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191374</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191374</guid><description><![CDATA[<p>abstract: The Health Care Financing Administration's (HCFA) approach to measuring quality of care uses an accepted definition of quality, explicit domains of measurement, and a formal validation procedure that includes face validity, construct validity, reliability, clinical validation, and tests for usefulness. The indicators of quality for Medicare and Medicaid patients span the range of service types, medical conditions, and payment systems and rest on a variety of data systems. Some have already been incorporated into operational systems while others are scheduled for incorporation over the next 3 years.</p><p>authors: N/A</p><p>issue_mesh: Aged : Health Services for the Aged/standards/utilization : Health Services Research/methods : Human : Medicaid/standards : Medicare/standards : Outcome and Process Assessment (Health Care) : Program Development : Quality Assurance, Health Care : Quality of Health Care/standards : Reproducibility of Results : United States : United States Health Care Financing Administration</p><p>issue_number: 4</p><p>ntis_number: PB99-106445</p><p>page_range: 39-54</p><p>primary_author: Jencks, Stephen F</p><p>title: Measuring quality of care under Medicare and Medicaid.</p><p>volume: 16</p><p>year_period: 1995 Summer</p>]]></description></item><item><title>Medicaid reform in the 1990s.</title><pubDate>Mon, 04 Nov 2019 02:27:39 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191661</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191661</guid><description><![CDATA[<p>page_range: 1-5</p><p>primary_author: Boben, Paul J</p><p>title: Medicaid reform in the 1990s.</p><p>volume: 22</p><p>year_period: 2000 Winter</p>]]></description></item><item><title>Thirty years of Medicine: a personal reflection on Medicare's impact on black Americans.</title><pubDate>Mon, 04 Nov 2019 02:27:39 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191470</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191470</guid><description><![CDATA[<p>authors: N/A</p><p>issue_mesh: Blacks : Civil Rights/legislation &#x26; jurisprudence : Health Services Accessibility/economics : History of Medicine, 20th Cent. : Medicare/history : Policy Making : Program Evaluation : Social Justice : United States</p><p>issue_number: 2</p><p>ntis_number: PB98-110885</p><p>page_range: 87-90</p><p>primary_author: Height, Dorothy</p><p>title: Thirty years of Medicine: a personal reflection on Medicare's impact on black Americans.</p><p>volume: 18</p><p>year_period: 1996 Winter</p>]]></description></item><item><title>Medicare: 35 years of service.</title><pubDate>Mon, 04 Nov 2019 02:27:38 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191652</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191652</guid><description><![CDATA[<p>abstract: For persons who are trying to understand what we were up to, the first broad point to keep in mind is that all of us who developed Medicare and fought for it had been advocates of universal national health insurance. We all saw insurance for the elderly as a fallback position, which we advocated solely because it seemed to have the best chance politically. Although the public record contains some explicit denials, we expect Medicare to be a first step toward universal national health insurance, perhaps with "Kiddicare" as another step President Franklin Roosevelt feared that health insurance was so controversial, because of doctor's opposition, that if he included it in his program for economic security he might lose the entire program. Robert M. Ball, Social Security Commissioner under Presidents Kennedy, Johnson, and Nixon, 1995.</p><p>authors: N/A</p><p>issue_mesh: Medicare : Universal Coverage : Aged : United States : United States Health Care Financing Administration</p><p>issue_number: 1</p><p>ntis_number: PB2001-105913</p><p>page_range: 75-103</p><p>primary_author: DeLew, Nancy A</p><p>title: Medicare: 35 years of service.</p><p>volume: 22</p><p>year_period: 2000 Fall</p>]]></description></item><item><title>Capturing and Classifying Functional Status Information in Administrative Databases</title><pubDate>Mon, 04 Nov 2019 02:27:38 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191741</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191741</guid><description><![CDATA[<p>page_range: 61-76</p><p>primary_author: Iezzoni, Lisa</p><p>title: Capturing and Classifying Functional Status Information in Administrative Databases</p><p>volume: 24</p><p>year_period: 2003 Spring</p>]]></description></item><item><title>National health projections through 2008</title><pubDate>Mon, 04 Nov 2019 02:27:38 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191623</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191623</guid><description><![CDATA[<p>page_range: 211-237</p><p>primary_author: Smith, Sheila</p><p>title: National health projections through 2008</p><p>volume: 21</p><p>year_period: 1999 Winter</p>]]></description></item><item><title>Rolling Back Medicare Home Health</title><pubDate>Mon, 04 Nov 2019 02:27:38 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191731</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191731</guid><description><![CDATA[<p>page_range: 33-55</p><p>primary_author: Komisar, Harriet</p><p>title: Rolling Back Medicare Home Health</p><p>volume: 24</p><p>year_period: 2002 Winter</p>]]></description></item><item><title>Measuring Function for Medicare Inpatient Rehabilitation Payment</title><pubDate>Mon, 04 Nov 2019 02:27:38 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191739</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191739</guid><description><![CDATA[<p>page_range: 25-44</p><p>primary_author: Carter, Grace</p><p>title: Measuring Function for Medicare Inpatient Rehabilitation Payment</p><p>volume: 24</p><p>year_period: 2003 Spring</p>]]></description></item><item><title>Health reform, year seven: Observations about Medicaid managed care.</title><pubDate>Mon, 04 Nov 2019 02:27:38 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191657</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191657</guid><description><![CDATA[<p>abstract: Over the last 7 years, State and Federal policymakers have reformed State medical assistance programs and, in the process, have grappled with goals of both containing program costs and expanding health insurance coverage to the uninsured. Currently, nearly one-quarter of all States have implemented health care reform demonstrations, and this article summarizes trends seen since health care reform began in the 1990s. As well as noting the accomplishments of health care reform through the use of Medicaid managed care, this article speculates, based on recent evidence, about new directions health care reform may take in the future.</p><p>authors: N/A</p><p>issue_mesh: Managed Care Programs/economics/legislation &#x26; jurisprudence : Medicaid : State Government : United States : United States Health Care Financing Administration</p><p>issue_number: 1</p><p>ntis_number: PB2001-105913</p><p>page_range: 127-132</p><p>primary_author: Cagey, Clarke</p><p>title: Health reform, year seven: Observations about Medicaid managed care.</p><p>volume: 22</p><p>year_period: 2000 Fall</p>]]></description></item><item><title>Why Medicare Part A and Part B, as well as Medicaid?</title><pubDate>Mon, 04 Nov 2019 02:27:38 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191648</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191648</guid><description><![CDATA[<p>issue_number: 1</p><p>ntis_number: PB2001-105913</p><p>page_range: 53-54</p><p>primary_author: Myers, Robert J</p><p>title: Why Medicare Part A and Part B, as well as Medicaid?</p><p>volume: 22</p><p>year_period: 2000 Fall</p>]]></description></item><item><title>National health expenditures, 1999.</title><pubDate>Mon, 04 Nov 2019 02:27:38 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191688</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191688</guid><description><![CDATA[<p>page_range: 77-110</p><p>primary_author: Cowan, Cathy A</p><p>title: National health expenditures, 1999.</p><p>volume: 22</p><p>year_period: 2001 Summer</p>]]></description></item><item><title>Medicare matters: Building on a record of accomplishments.</title><pubDate>Mon, 04 Nov 2019 02:27:38 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191645</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191645</guid><description><![CDATA[<p>abstract: Medicare's success over the past 35 years include doubling the number of persons age 65 or over with health insurance, increasing access to mainstream health care services, and substantially reducing the financial burdens faced by older Americans. Medicare reform remains high on the list of priorities of many policymakers because of rapid past and expected future growth in Medicare. If the original goals of the program - including providing mainstream care, pooling of risks, and offering help to those most in need - are to be protected, however, a go-slow approach for greater reliance on the private sector is in order.</p><p>authors: N/A</p><p>issue_mesh: Medicaid : Medicare : Aged : History of Medicine, 20th Cent. : Insurance, Health : United States : United States Health Care Financing Administration</p><p>issue_number: 1</p><p>ntis_number: PB2001-105913</p><p>page_range: 9-22</p><p>primary_author: Moon, Marilyn</p><p>title: Medicare matters: Building on a record of accomplishments.</p><p>volume: 22</p><p>year_period: 2000 Fall</p>]]></description></item><item><title>What can the U.S. learn from national health accounting elsewhere?</title><pubDate>Mon, 04 Nov 2019 02:27:38 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191617</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191617</guid><description><![CDATA[<p>page_range: 47-63</p><p>primary_author: Berman, Peter</p><p>title: What can the U.S. learn from national health accounting elsewhere?</p><p>volume: 21</p><p>year_period: 1999 Winter</p>]]></description></item><item><title>An overview: Eliminating racial, ethnic, and SES disparities in health care</title><pubDate>Mon, 04 Nov 2019 02:27:38 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191638</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191638</guid><description><![CDATA[<p>page_range: 1-7</p><p>primary_author: DeLew, Nancy</p><p>title: An overview: Eliminating racial, ethnic, and SES disparities in health care</p><p>volume: 21</p><p>year_period: 2000 Summer</p>]]></description></item><item><title>Covering uninsured adults through Medicaid: Lessons from the Oregon health plan.</title><pubDate>Mon, 04 Nov 2019 02:27:38 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191668</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191668</guid><description><![CDATA[<p>page_range: 119-135</p><p>primary_author: Haber, Susan</p><p>title: Covering uninsured adults through Medicaid: Lessons from the Oregon health plan.</p><p>volume: 22</p><p>year_period: 2000 Winter</p>]]></description></item><item><title>An overview: The future of plan performance measurement.</title><pubDate>Mon, 04 Nov 2019 02:27:38 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191672</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191672</guid><description><![CDATA[<p>page_range: 1-5</p><p>primary_author: Sheingold, Steven H</p><p>title: An overview: The future of plan performance measurement.</p><p>volume: 22</p><p>year_period: 2001 Spring</p>]]></description></item><item><title>Risk Selection and Benefits in the Medicare+Choice Program</title><pubDate>Mon, 04 Nov 2019 02:27:38 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191759</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191759</guid><description><![CDATA[<p>page_range: 23-36</p><p>primary_author: Feldman, Roger</p><p>title: Risk Selection and Benefits in the Medicare+Choice Program</p><p>volume: 25</p><p>year_period: 2003 Fall</p>]]></description></item><item><title>Health Expenditure Trends in OECD Countries, 1990-2001</title><pubDate>Mon, 04 Nov 2019 02:27:38 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191758</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191758</guid><description><![CDATA[<p>page_range: 1-22</p><p>primary_author: Huber, Manfred</p><p>title: Health Expenditure Trends in OECD Countries, 1990-2001</p><p>volume: 25</p><p>year_period: 2003 Fall</p>]]></description></item><item><title>National health expenditures, 1998</title><pubDate>Mon, 04 Nov 2019 02:27:38 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191622</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191622</guid><description><![CDATA[<p>page_range: 165-210</p><p>primary_author: Cowan, Cathy A</p><p>title: National health expenditures, 1998</p><p>volume: 21</p><p>year_period: 1999 Winter</p>]]></description></item><item><title>Medicaid and the HIV/AIDS epidemic in the United States.</title><pubDate>Mon, 04 Nov 2019 02:27:38 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191655</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191655</guid><description><![CDATA[<p>abstract: This article explores the impact on Medicaid costs of new AIDS treatments and other technology advances. Available data on total projected Medicaid expenditures and actual expenditures for antiretroviral drugs are presented. The article further addresses Medicaid State agencies' efforts to assure that Medicaid-eligible persons with AIDS receive quality care, and reviews recent studies on utilization of services among persons with HIV disease.</p><p>authors: N/A</p><p>issue_mesh: Acquired Immunodeficiency Syndrome/economics : Health Expenditures : HIV Infections/economics : Medicaid : Health Services/utilization : Quality of Health Care : Technology, Medical/economics : United States : United States Health Care Financing Administration</p><p>issue_number: 1</p><p>ntis_number: PB2001-105913</p><p>page_range: 117-122</p><p>primary_author: Graydon, T Randolph</p><p>title: Medicaid and the HIV/AIDS epidemic in the United States.</p><p>volume: 22</p><p>year_period: 2000 Fall</p>]]></description></item><item><title>A clinically detailed risk information system for cost</title><pubDate>Mon, 04 Nov 2019 02:27:38 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191628</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191628</guid><description><![CDATA[<p>page_range: 65-91</p><p>primary_author: Carter, Grace M</p><p>title: A clinically detailed risk information system for cost</p><p>volume: 21</p><p>year_period: 2000 Spring</p>]]></description></item><item><title>Improving health-based payment for Medicaid beneficiaries: CDPS</title><pubDate>Mon, 04 Nov 2019 02:27:38 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191627</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191627</guid><description><![CDATA[<p>page_range: 29-64</p><p>primary_author: Kronick, Richard</p><p>title: Improving health-based payment for Medicaid beneficiaries: CDPS</p><p>volume: 21</p><p>year_period: 2000 Spring</p>]]></description></item><item><title>Medicaid and the health of children.</title><pubDate>Mon, 04 Nov 2019 02:27:38 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191658</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191658</guid><description><![CDATA[<p>abstract: The Medicaid program has evolved and expanded since its inception in 1965, providing health insurance coverage for ever-increasing number of children living in poverty. During the first 35 years of Medicaid, the program has expanded coverage to include preventive services for children, expanded eligibility criteria to include uninsured children not receiving welfare. The Medicaid program has encouraged innovation in the form of managed care and primary care case management. Most recently, the State Children's Health Insurance Program (CHIP) has given States freedom in providing more children with coverage. Medicaid has had a powerful influence on the health of the Nation's children. Because of Medicaid coverage, fewer children die, and children have less severe illnesses, fewer hospitalizations, fewer emergency department visits, more preventive care, and more immunizations than they would have had they not been insured.</p><p>authors: Boben, Paul J; Bonney, Jennifer B</p><p>issue_mesh: Child : Medicaid/statistics &#x26; numerical data : Case Management : Eligibility Determination : Managed Care Programs : Poverty : Preventive Health Services : Primary Health Care : State Government : United States : United States Health Care Financing Administration</p><p>issue_number: 1</p><p>ntis_number: PB2001-105913</p><p>page_range: 133-140</p><p>primary_author: Hakim, Rosemarie B</p><p>title: Medicaid and the health of children.</p><p>volume: 22</p><p>year_period: 2000 Fall</p>]]></description></item><item><title>Second-Generation Medicaid managed care: Can it deliver?</title><pubDate>Mon, 04 Nov 2019 02:27:37 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191663</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191663</guid><description><![CDATA[<p>page_range: 29-47</p><p>primary_author: Gold, Marsha</p><p>title: Second-Generation Medicaid managed care: Can it deliver?</p><p>volume: 22</p><p>year_period: 2000 Winter</p>]]></description></item><item><title>Risk adjustment for health plans disproportionately enrolling frail Medicare beneficiaries</title><pubDate>Mon, 04 Nov 2019 02:27:37 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191632</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191632</guid><description><![CDATA[<p>page_range: 135-148</p><p>primary_author: Riley, Gerald F</p><p>title: Risk adjustment for health plans disproportionately enrolling frail Medicare beneficiaries</p><p>volume: 21</p><p>year_period: 2000 Spring</p>]]></description></item><item><title>Measuring the quality of care in different settings.</title><pubDate>Mon, 04 Nov 2019 02:27:37 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191677</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191677</guid><description><![CDATA[<p>page_range: 59-70</p><p>primary_author: Docteur, Elizabeth R</p><p>title: Measuring the quality of care in different settings.</p><p>volume: 22</p><p>year_period: 2001 Spring</p>]]></description></item><item><title>Overview, history, and objectives of performance measurement.</title><pubDate>Mon, 04 Nov 2019 02:27:37 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191673</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191673</guid><description><![CDATA[<p>page_range: 7-21</p><p>primary_author: McIntyre, Dennis</p><p>title: Overview, history, and objectives of performance measurement.</p><p>volume: 22</p><p>year_period: 2001 Spring</p>]]></description></item><item><title>Evidence of innovative uses of performance measures among purchasers.</title><pubDate>Mon, 04 Nov 2019 02:27:37 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191675</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191675</guid><description><![CDATA[<p>page_range: 35-47</p><p>primary_author: Zema, Carla L</p><p>title: Evidence of innovative uses of performance measures among purchasers.</p><p>volume: 22</p><p>year_period: 2001 Spring</p>]]></description></item><item><title>Medicare risk-adjusted capitation payments: from research to implementation</title><pubDate>Mon, 04 Nov 2019 02:27:37 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191625</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191625</guid><description><![CDATA[<p>page_range: 1-5</p><p>primary_author: Greenwald, Leslie M</p><p>title: Medicare risk-adjusted capitation payments: from research to implementation</p><p>volume: 21</p><p>year_period: 2000 Spring</p>]]></description></item><item><title>Trends in Medicare expenditures and financial status, 1966-2000.</title><pubDate>Mon, 04 Nov 2019 02:27:37 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191647</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191647</guid><description><![CDATA[<p>abstract: In this article, the author reviews expenditure growth trends over Medicare's 35-year history and comments on how the program's long-range financial outlook has changed over time. The author focuses on the various legislative, economic, and demographic factors that have affected expenditure growth and financial status. In addition, Medicare's share of total U.S. health costs is briefly reviewed. In an appended comment, the author considers whether the impact of the Balanced Budget Act of 1997 (BBA) was greater than intended by Congress and the Administration. The author concludes with a plea for greater attention to correcting the projected long-range deficits for the Hospital Insurance (HI) Trust Fund.</p><p>authors: N/A</p><p>issue_mesh: Health Expenditures : Medicare : Aged : Financial Management/trends : Government : Insurance/economics : United States : United States Health Care Financing Administration</p><p>issue_number: 1</p><p>ntis_number: PB2001-105913</p><p>page_range: 35-51</p><p>primary_author: Foster, Richard S</p><p>title: Trends in Medicare expenditures and financial status, 1966-2000.</p><p>volume: 22</p><p>year_period: 2000 Fall</p>]]></description></item><item><title>Medicaid spending: A brief history.</title><pubDate>Mon, 04 Nov 2019 02:27:37 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191653</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191653</guid><description><![CDATA[<p>abstract: Medicaid spending has varied greatly over time. This article uses financial and statistical data to trace the history of Medicaid spending in relation to some of the major factors that have influenced its growth over the years. Periods of varying growth are divided into eight "eras," ranging from program startup in 1966 through the post-welfare reform period. Average expenditure and enrollee growth for each era are presented and briefly discussed. Finally, some factors are mentioned that are likely to affect future growth in the Medicaid program.</p><p>authors: N/A</p><p>issue_mesh: Health Expenditures : Medicaid/statistics &#x26; numerical data/trends : United States : United States Health Care Financing Administration</p><p>issue_number: 1</p><p>ntis_number: PB2001-105913</p><p>page_range: 105-112</p><p>primary_author: Klemm, John D</p><p>title: Medicaid spending: A brief history.</p><p>volume: 22</p><p>year_period: 2000 Fall</p>]]></description></item><item><title>Evolution of Medicaid managed care systems and eligibility expansions.</title><pubDate>Mon, 04 Nov 2019 02:27:37 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191662</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191662</guid><description><![CDATA[<p>page_range: 7-27</p><p>primary_author: Ku, Leighton</p><p>title: Evolution of Medicaid managed care systems and eligibility expansions.</p><p>volume: 22</p><p>year_period: 2000 Winter</p>]]></description></item><item><title>Perils of pioneering: Monitoring Medicaid managed care.</title><pubDate>Mon, 04 Nov 2019 02:27:37 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191665</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191665</guid><description><![CDATA[<p>page_range: 61-83</p><p>primary_author: Wooldridge, Judith</p><p>title: Perils of pioneering: Monitoring Medicaid managed care.</p><p>volume: 22</p><p>year_period: 2000 Winter</p>]]></description></item><item><title>Modeling Medicare costs of PACE populations</title><pubDate>Mon, 04 Nov 2019 02:27:37 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191633</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191633</guid><description><![CDATA[<p>page_range: 149-170</p><p>primary_author: Robinson, James</p><p>title: Modeling Medicare costs of PACE populations</p><p>volume: 21</p><p>year_period: 2000 Spring</p>]]></description></item><item><title>Federally qualified health centers: Surviving Medicaid managed care, but not thriving.</title><pubDate>Mon, 04 Nov 2019 02:27:37 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191667</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191667</guid><description><![CDATA[<p>page_range: 103-117</p><p>primary_author: Hoag, Sheila D</p><p>title: Federally qualified health centers: Surviving Medicaid managed care, but not thriving.</p><p>volume: 22</p><p>year_period: 2000 Winter</p>]]></description></item><item><title>Medicare Health Maintenance Organization Benefits Packages and Plan Performance Measures</title><pubDate>Mon, 04 Nov 2019 02:27:36 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191725</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191725</guid><description><![CDATA[<p>page_range: 133-144</p><p>primary_author: Cox, Don</p><p>title: Medicare Health Maintenance Organization Benefits Packages and Plan Performance Measures</p><p>volume: 24</p><p>year_period: 2002 Fall</p>]]></description></item><item><title>Premium Rebates and the Quiet Consensus on Market Reform for Medicare</title><pubDate>Mon, 04 Nov 2019 02:27:36 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191708</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191708</guid><description><![CDATA[<p>page_range: 19-33</p><p>primary_author: Feldman, Roger</p><p>title: Premium Rebates and the Quiet Consensus on Market Reform for Medicare</p><p>volume: 23</p><p>year_period: 2001 Winter</p>]]></description></item><item><title>Satisfaction with health care of dually eligible older beneficiaries.</title><pubDate>Mon, 04 Nov 2019 02:27:36 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191692</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191692</guid><description><![CDATA[<p>page_range: 175-186</p><p>primary_author: Burton, Lynda C</p><p>title: Satisfaction with health care of dually eligible older beneficiaries.</p><p>volume: 22</p><p>year_period: 2001 Summer</p>]]></description></item><item><title>Rates of hospitalization for ambulatory care sensitive conditions in the Medicare+Choice population.</title><pubDate>Mon, 04 Nov 2019 02:27:36 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191682</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191682</guid><description><![CDATA[<p>page_range: 127-145</p><p>primary_author: McCall, Nancy</p><p>title: Rates of hospitalization for ambulatory care sensitive conditions in the Medicare+Choice population.</p><p>volume: 22</p><p>year_period: 2001 Spring</p>]]></description></item><item><title>Trends in State health care expenditures and funding: 1980-1998.</title><pubDate>Mon, 04 Nov 2019 02:27:36 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191689</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191689</guid><description><![CDATA[<p>page_range: 111-140</p><p>primary_author: Martin, Anne B</p><p>title: Trends in State health care expenditures and funding: 1980-1998.</p><p>volume: 22</p><p>year_period: 2001 Summer</p>]]></description></item><item><title>Beneficiary survey-based feedback on new Medicare information materials.</title><pubDate>Mon, 04 Nov 2019 02:27:36 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191697</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191697</guid><description><![CDATA[<p>page_range: 37-46</p><p>primary_author: McCormack, Lauren A</p><p>title: Beneficiary survey-based feedback on new Medicare information materials.</p><p>volume: 23</p><p>year_period: 2001 Fall</p>]]></description></item><item><title>Medicare's end stage renal disease program.</title><pubDate>Mon, 04 Nov 2019 02:27:36 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191649</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191649</guid><description><![CDATA[<p>abstract: Perhaps no other Federal Government program can lay claim to have saved as many lives as the Medicare end stage renal disease (ESRD) program. Since its inception in 1973, as a result of the Social Security Amendment of 1972 (Public Law 92-603, section 299I), over 1 million persons have received life-saving renal replacement therapy under this program. Prior to the enactment of this legislation, treatment was limited to a very few patients due to its extremely high cost and the limited number of dialysis machines. In the 1960s, it was not uncommon for hospitals that had dialysis machines to appoint special committees to review applicants for dialysis and decide who should receive treatment, the others were left to die of renal failure. Public Law 92-603 removed this odious task from the nephrology community. A person with ESRD is entitled to Medicare if he/she is fully or currently insured for benefits under Social Security, or is a spouse or dependent of an insured person. Consequently, entitlement is less than universal, with 92 percent of all persons with ESRD qualifying for Medicare coverage.</p><p>authors: N/A</p><p>issue_mesh: Hemodialysis/utilization : Medicare : Aged : Insurance, Health : Kidney Failure, Chronic : Social Security : United States : United States Health Care Financing Administration</p><p>issue_number: 1</p><p>ntis_number: PB2001-105913</p><p>page_range: 55-60</p><p>primary_author: Eggers, Paul W</p><p>title: Medicare's end stage renal disease program.</p><p>volume: 22</p><p>year_period: 2000 Fall</p>]]></description></item><item><title>Access to care and use of health services by low-income women.</title><pubDate>Mon, 04 Nov 2019 02:27:36 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191685</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191685</guid><description><![CDATA[<p>page_range: 27-47</p><p>primary_author: Almeida, Ruth A</p><p>title: Access to care and use of health services by low-income women.</p><p>volume: 22</p><p>year_period: 2001 Summer</p>]]></description></item><item><title>Reforming the Medicaid disproportionate share hospital program</title><pubDate>Mon, 04 Nov 2019 02:27:36 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191669</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191669</guid><description><![CDATA[<p>page_range: 137-157</p><p>primary_author: Coughlin, Teresa A</p><p>title: Reforming the Medicaid disproportionate share hospital program</p><p>volume: 22</p><p>year_period: 2000 Winter</p>]]></description></item><item><title>Business, households, and governments: health spending, 1991.</title><pubDate>Mon, 04 Nov 2019 02:27:36 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191273</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191273</guid><description><![CDATA[<p>abstract: Governments have been thrust to the forefront of health care reform efforts as growth in government health care costs was faster than growth in all other sponsor sectors in 1991. In the business sector, real health care costs per worker have risen 65 times faster than real wages and salaries per worker during the past 26 years. Households continue to devote 5 percent of income after taxes to health care, the same percentage for the last 8 years. This article presents data supporting these findings, and an analysis of health care spending by each sponsor sector.</p><p>authors: McDonnell, Patricia A</p><p>issue_mesh: Commerce/economics : Data Collection : Employer Health Costs/statistics &#x26; numerical data : Financing, Personal/statistics &#x26; numerical data : Health Benefit Plans, Employee/economics : Health Expenditures/statistics &#x26; numerical data : Private Sector/economics/statistics &#x26; numerical data : Public Sector/economics/statistics &#x26; numerical data : United States</p><p>issue_number: 3</p><p>ntis_number: PB95-111274</p><p>page_range: 227-248</p><p>primary_author: Cowan, Cathy A</p><p>title: Business, households, and governments: health spending, 1991.</p><p>volume: 14</p><p>year_period: 1993 Spring</p>]]></description></item><item><title>Physician fee levels: Medicare versus Canada.</title><pubDate>Mon, 04 Nov 2019 02:27:36 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191265</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191265</guid><description><![CDATA[<p>abstract: Adjusted for differences in purchasing power and practice expenses, Canadian physician fees are, on average, 59 percent of Medicare fees. The general perception that Medicare fees are low is the result of comparison with U.S. private fees, not to the much lower Canadian fees. In the context of the current U.S. health care system, lowering Medicare fees to Canadian levels could jeopardize access to care by Medicare beneficiaries. However, if all payers used the same fee schedule, fees that differed substantially from those currently used by private insurers might be viable.</p><p>authors: Katz, Steven J; Zuckerman, Stephen</p><p>issue_mesh: Canada : Comparative Study : Cost Control/economics : Data Collection : Fee Schedules/economics : Fees, Medical/classification/standards : Income/statistics &#x26; numerical data : Insurance, Physician Services/economics : Medical Records/classification : Medicare Part B/economics : National Health Programs/economics : Rate Setting and Review/standards : Support, U.S. Gov't, Non-P.H.S. : United States</p><p>issue_number: 3</p><p>ntis_number: PB95-111274</p><p>page_range: 41-54</p><p>primary_author: Welch, W Pete</p><p>title: Physician fee levels: Medicare versus Canada.</p><p>volume: 14</p><p>year_period: 1993 Spring</p>]]></description></item><item><title>New directions for Medicare payment systems.</title><pubDate>Mon, 04 Nov 2019 02:27:36 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191346</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191346</guid><description><![CDATA[<p>abstract: This overview discusses articles published in this issue of the Health Care Financing Review, entitled "Medicare Payment Systems: Moving Toward the Future." These articles focus on the ongoing development of Medicare payment methodologies, their adoption by non-Medicare payers, and issues to be addressed in the development of all-payer systems based on these methodologies.</p><p>authors: Friedman, Maria A; Sobaski, William</p><p>issue_mesh: Long-Term Care : Medicare/economics/trends : Reimbursement Mechanisms/organization &#x26; administration/trends : United States</p><p>issue_number: 2</p><p>ntis_number: PB99-106486</p><p>page_range: 1-11</p><p>primary_author: Goody, Brigid</p><p>title: New directions for Medicare payment systems.</p><p>volume: 16</p><p>year_period: 1994 Winter</p>]]></description></item><item><title>Excess demand and cost relationships among Kentucky nursing homes.</title><pubDate>Mon, 04 Nov 2019 02:27:36 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191329</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191329</guid><description><![CDATA[<p>abstract: This article examines the influence of excess demand on nursing home costs. Previous work indicates that excess demand, reflected in a pervasive shortage of nursing home beds, constrains market competition and patient care expenditures. According to this view, nursing homes located in underbedded markets can reduce costs and quality with impunity because there is no pressure to compete for residents. Predictions based on the excess demand argument were tested using 1989 data from a sample of 179 Kentucky nursing homes. Overall, the results provide partial support for the excess demand argument. Factors that may counteract the influence of excess demand are considered. Finally, the role of competition in nursing home markets and difficulties associated with making it operational are discussed.</p><p>authors: Freeman, James W</p><p>issue_mesh: Bed Occupancy : Cost Allocation : Data Collection : Economic Competition : Health Care Costs/statistics &#x26; numerical data : Health Facility Size : Health Services Needs and Demand/economics/statistics &#x26; numerical data : Health Services Research : Kentucky : Medicaid : Nursing Homes/economics/statistics &#x26; numerical data/standards/utilization : Policy Making : Quality of Health Care : Regression Analysis : United States</p><p>issue_number: 4</p><p>ntis_number: PB99-106437</p><p>page_range: 137-152</p><p>primary_author: Davis, Mark A</p><p>title: Excess demand and cost relationships among Kentucky nursing homes.</p><p>volume: 15</p><p>year_period: 1994 Summer</p>]]></description></item><item><title>Do hospitals behave like consumers? An analysis of expenditures and revenues.</title><pubDate>Mon, 04 Nov 2019 02:27:36 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191257</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191257</guid><description><![CDATA[<p>abstract: Hospitals adjust expenditures to be a constant proportion of their revenues. An unexpected 10-percent change in hospital revenue generates a 3.5-4.8 percent expenditure change (in the same direction) the year it occurs, with declining changes thereafter (10 percent in total). Non-profit and government hospitals adjust expenditures about 80 percent of the way toward their longrun change near the end of the third year of the revenue change; for-profit hospitals do this at the end of the fourth year. Hospitals with revenue increases make an 80-percent adjustment toward the end of the third year; those with revenue declines do so near the end of the fourth year.</p><p>authors: N/A</p><p>issue_mesh: Models, Econometric : Capital Expenditures/statistics &#x26; numerical data : Consumer Participation/economics : Financial Management, Hospital/statistics &#x26; numerical data : Income/statistics &#x26; numerical data : Medicare : Prospective Payment System : Regression Analysis : United States</p><p>issue_number: 2</p><p>ntis_number: PB2001-105739</p><p>page_range: 125-134</p><p>primary_author: Peden, Edgar A</p><p>title: Do hospitals behave like consumers? An analysis of expenditures and revenues.</p><p>volume: 14</p><p>year_period: 1992 Winter</p>]]></description></item><item><title>A layman's guide to the U.S. health care system.</title><pubDate>Mon, 04 Nov 2019 02:27:36 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191247</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191247</guid><description><![CDATA[<p>abstract: This article provides an overview of the U.S. health care system and recent proposals for health system reform. Prepared for a 15-nation comparative study for the Organization for Economic Cooperation and Development (OECD), the article summarizes descriptive data on the financing, utilization, access, and supply of U.S. health services; analyzes health system cost growth and trends; reviews health reforms adopted in the 1980s; and discusses proposals in the current health system reform debate.</p><p>authors: Greenberg, George; Kinchen, Kraig</p><p>issue_mesh: Delivery of Health Care/organization &#x26; administration/trends : Health Benefit Plans, Employee/trends : Health Care Costs/statistics &#x26; numerical data/trends : Health Expenditures/statistics &#x26; numerical data/trends : Health Policy/economics/trends : Insurance, Health/trends : Managed Care Programs/trends : Medicaid/trends : Medicare/trends : Outcome Assessment (Health Care)/statistics &#x26; numerical data : Physicians/supply &#x26; distribution : State Health Plans/trends : United States</p><p>issue_number: 1</p><p>ntis_number: PB95-123279</p><p>page_range: 151-169</p><p>primary_author: DeLew, Nancy</p><p>title: A layman's guide to the U.S. health care system.</p><p>volume: 14</p><p>year_period: 1992 Fall</p>]]></description></item><item><title>Racial and ethnic differences in hospitalization rates among aged Medicare beneficiaries, 1988</title><pubDate>Mon, 04 Nov 2019 02:27:36 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191643</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191643</guid><description><![CDATA[<p>page_range: 91-105</p><p>primary_author: Eggers, Paul W</p><p>title: Racial and ethnic differences in hospitalization rates among aged Medicare beneficiaries, 1988</p><p>volume: 21</p><p>year_period: 2000 Summer</p>]]></description></item><item><title>Identification and Evaluation of Existing Nursing Homes Quality Indicators</title><pubDate>Mon, 04 Nov 2019 02:27:36 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191715</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191715</guid><description><![CDATA[<p>page_range: 19-36</p><p>primary_author: Berg, Katherine</p><p>title: Identification and Evaluation of Existing Nursing Homes Quality Indicators</p><p>volume: 23</p><p>year_period: 2002 Summer</p>]]></description></item><item><title>Hospital, employment, and price indicators for the health care industry: Third quarter 1999</title><pubDate>Mon, 04 Nov 2019 02:27:36 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191637</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191637</guid><description><![CDATA[<p>page_range: 231-273</p><p>primary_author: Martin, Shanon</p><p>title: Hospital, employment, and price indicators for the health care industry: Third quarter 1999</p><p>volume: 21</p><p>year_period: 2000 Spring</p>]]></description></item><item><title>Health disparities among older women enrolled in Medicare managed care.</title><pubDate>Mon, 04 Nov 2019 02:27:36 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191693</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191693</guid><description><![CDATA[<p>page_range: 187-201</p><p>primary_author: Bierman, Arlene S</p><p>title: Health disparities among older women enrolled in Medicare managed care.</p><p>volume: 22</p><p>year_period: 2001 Summer</p>]]></description></item><item><title>Comparison of Functional Status Tools Used in Post-Acute Care</title><pubDate>Mon, 04 Nov 2019 02:27:36 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191738</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191738</guid><description><![CDATA[<p>page_range: 13-24</p><p>primary_author: Jette, Alan</p><p>title: Comparison of Functional Status Tools Used in Post-Acute Care</p><p>volume: 24</p><p>year_period: 2003 Spring</p>]]></description></item><item><title>Health Care Access, Use, and Satisfaction Among Disabled Medicaid Beneficiaries</title><pubDate>Mon, 04 Nov 2019 02:27:35 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191735</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191735</guid><description><![CDATA[<p>page_range: 115-136</p><p>primary_author: Coughlin, Teresa</p><p>title: Health Care Access, Use, and Satisfaction Among Disabled Medicaid Beneficiaries</p><p>volume: 24</p><p>year_period: 2002 Winter</p>]]></description></item><item><title>Long-Term Care Hospitals Under Medicare: Facility-Level Characteristics</title><pubDate>Mon, 04 Nov 2019 02:27:35 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191707</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191707</guid><description><![CDATA[<p>page_range: 1-18</p><p>primary_author: Liu, Korbin</p><p>title: Long-Term Care Hospitals Under Medicare: Facility-Level Characteristics</p><p>volume: 23</p><p>year_period: 2001 Winter</p>]]></description></item><item><title>Functional Status and Health Information in Canada: Proposals and Prospects</title><pubDate>Mon, 04 Nov 2019 02:27:35 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191743</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191743</guid><description><![CDATA[<p>page_range: 89-102</p><p>primary_author: Harris, Marcelline</p><p>title: Functional Status and Health Information in Canada: Proposals and Prospects</p><p>volume: 24</p><p>year_period: 2003 Spring</p>]]></description></item><item><title>Issues in Managed Care</title><pubDate>Mon, 04 Nov 2019 02:27:35 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191717</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191717</guid><description><![CDATA[<p>page_range: 1-10</p><p>primary_author: Zarabozo, Carlos</p><p>title: Issues in Managed Care</p><p>volume: 24</p><p>year_period: 2002 Fall</p>]]></description></item><item><title>Comparison of Medicare Risk HMO and FFS Enrollees</title><pubDate>Mon, 04 Nov 2019 02:27:35 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191727</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191727</guid><description><![CDATA[<p>page_range: 177-185</p><p>primary_author: Murgolo, Maggie</p><p>title: Comparison of Medicare Risk HMO and FFS Enrollees</p><p>volume: 24</p><p>year_period: 2002 Fall</p>]]></description></item><item><title>Medicare beneficiary satisfaction with durable medical equipment suppliers.</title><pubDate>Mon, 04 Nov 2019 02:27:35 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191703</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191703</guid><description><![CDATA[<p>page_range: 123-136</p><p>primary_author: Hoerger, Thomas J</p><p>title: Medicare beneficiary satisfaction with durable medical equipment suppliers.</p><p>volume: 23</p><p>year_period: 2001 Fall</p>]]></description></item><item><title>Lessons learned from the national Medicare &#x26; You education program</title><pubDate>Mon, 04 Nov 2019 02:27:35 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191695</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191695</guid><description><![CDATA[<p>page_range: 5-20</p><p>primary_author: Goldstein, Elizabeth</p><p>title: Lessons learned from the national Medicare &#x26; You education program</p><p>volume: 23</p><p>year_period: 2001 Fall</p>]]></description></item><item><title>Supplemental Insurance for Community Aged and Disabled Beneficiaries: 1999</title><pubDate>Mon, 04 Nov 2019 02:27:35 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191712</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191712</guid><description><![CDATA[<p>page_range: 161-163</p><p>primary_author: Murray, Lauren</p><p>title: Supplemental Insurance for Community Aged and Disabled Beneficiaries: 1999</p><p>volume: 23</p><p>year_period: 2002 Spring</p>]]></description></item><item><title>Medicaid: 35 years of service.</title><pubDate>Mon, 04 Nov 2019 02:27:35 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191659</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191659</guid><description><![CDATA[<p>abstract: On this 35th anniversary of the enactment of Medicaid, it is important to reflect on the program's role in the U.S. health care system. The Medicaid program is the third largest source of health insurance in the United States - after employer-based coverage and Medicare. The significance of Medicaid's role in providing health insurance cannot be overstated. As the largest in the Federal safety net of public assistance programs, Medicaid provides essential medical and medically related services to the most vulnerable populations in society. In 1998, the Medicaid program covered 41.4 million low-income children, their families, elderly people, and individuals with disabilities - approximately 12 percent of the total U.S. population. Since its inception in 1965, Medicaid enrollment and expenditures have grown substantially. In addition, the program has evolved as Federal and State governments balance social, economic, and political factors affecting this and other public assistance programs. This article presents an overview of the Medicaid program and highlights trends in enrollment and expenditures.</p><p>authors: Hughes, Paul</p><p>issue_mesh: Medicaid/statistics &#x26; numerical data : Aged : Child : Disabled Persons : Health Expenditures : Poverty : United States : United States Health Care Financing Administration</p><p>issue_number: 1</p><p>ntis_number: PB2001-105913</p><p>page_range: 141-174</p><p>primary_author: Provost, Christie</p><p>title: Medicaid: 35 years of service.</p><p>volume: 22</p><p>year_period: 2000 Fall</p>]]></description></item><item><title>Medicaid Managed Care and Working-Age Beneficiaries with Disabilities and Chronic Illnesses</title><pubDate>Mon, 04 Nov 2019 02:27:35 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191719</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191719</guid><description><![CDATA[<p>page_range: 27-42</p><p>primary_author: Ireys, Henry</p><p>title: Medicaid Managed Care and Working-Age Beneficiaries with Disabilities and Chronic Illnesses</p><p>volume: 20</p><p>year_period: 2002 Fall</p>]]></description></item><item><title>Patterns of Medicaid expenditures after AIDS diagnosis.</title><pubDate>Mon, 04 Nov 2019 02:27:35 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191323</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191323</guid><description><![CDATA[<p>abstract: This article examines average monthly Medicaid expenditures after diagnosis of acquired immunodeficiency syndrome (AIDS) for the diagnosis, mid-illness, and death intervals, as well as Kaplan-Meier estimates of expenditures from AIDS diagnosis to death. A clinical severity measure (the Severity Index for Adults with AIDS [SIAA]) designed to be predictive of patient survival was applied to a population of continuously enrolled New York State Medicaid patients who survived at least 6 months after being diagnosed with AIDS. Our findings suggest that groups of more seriously ill patients who appear to have more intense demand for health care services, especially over the diagnosis and mid-illness intervals, can be identified using the SIAA.</p><p>authors: Fanning, Thomas R; Houchens, Robert; Mauskopf, Josephine; McKee, Linda; Turner, Barbara J</p><p>issue_mesh: Severity of Illness Index : Acquired Immunodeficiency Syndrome/classification/complications/economics/mortality : Adult : Data Collection : Episode of Care : Female : Health Expenditures/statistics &#x26; numerical data : Health Services Research : Human : Male : Medicaid/statistics &#x26; numerical data/utilization : New York : Substance-Related Disorders/economics/epidemiology : Support, U.S. Gov't, P.H.S. : Survival Analysis : United States/epidemiology</p><p>issue_number: 4</p><p>ntis_number: PB99-106437</p><p>page_range: 43-59</p><p>primary_author: Markson, Leona E</p><p>title: Patterns of Medicaid expenditures after AIDS diagnosis.</p><p>volume: 15</p><p>year_period: 1994 Summer</p>]]></description></item><item><title>Principal inpatient diagnostic cost group model for Medicare risk adjustment</title><pubDate>Mon, 04 Nov 2019 02:27:35 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191629</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191629</guid><description><![CDATA[<p>page_range: 93-118</p><p>primary_author: Pope, Gregory C</p><p>title: Principal inpatient diagnostic cost group model for Medicare risk adjustment</p><p>volume: 21</p><p>year_period: 2000 Spring</p>]]></description></item><item><title>Impact of Medicare Managed Care Market Withdrawal on Beneficiaries</title><pubDate>Mon, 04 Nov 2019 02:27:35 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191723</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191723</guid><description><![CDATA[<p>page_range: 95-115</p><p>primary_author: Booske, Bridget</p><p>title: Impact of Medicare Managed Care Market Withdrawal on Beneficiaries</p><p>volume: 24</p><p>year_period: 2002 Fall</p>]]></description></item><item><title>Mammography rescreening among older California women.</title><pubDate>Mon, 04 Nov 2019 02:27:35 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191687</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191687</guid><description><![CDATA[<p>page_range: 63-75</p><p>primary_author: Sabogal, Fabio</p><p>title: Mammography rescreening among older California women.</p><p>volume: 22</p><p>year_period: 2001 Summer</p>]]></description></item><item><title>Constraining Medicare Home Health Reimbursement: What Are the Outcomes?</title><pubDate>Mon, 04 Nov 2019 02:27:35 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191732</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191732</guid><description><![CDATA[<p>page_range: 57-76</p><p>primary_author: McCall, Nelda</p><p>title: Constraining Medicare Home Health Reimbursement: What Are the Outcomes?</p><p>volume: 24</p><p>year_period: 2002 Winter</p>]]></description></item><item><title>Assessing Medicare health care performance in serving beneficiary subpopulations.</title><pubDate>Mon, 04 Nov 2019 02:27:35 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191679</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191679</guid><description><![CDATA[<p>page_range: 85-99</p><p>primary_author: Cox, Donald F</p><p>title: Assessing Medicare health care performance in serving beneficiary subpopulations.</p><p>volume: 22</p><p>year_period: 2001 Spring</p>]]></description></item><item><title>Medigap Reform Legislation of 1990: A 10-Year Review</title><pubDate>Mon, 04 Nov 2019 02:27:35 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191745</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191745</guid><description><![CDATA[<p>page_range: 121-137</p><p>primary_author: Fox, Peter</p><p>title: Medigap Reform Legislation of 1990: A 10-Year Review</p><p>volume: 24</p><p>year_period: 2003 Spring</p>]]></description></item><item><title>Disparities in Medicare services: Potential causes, plausible explanations, and recommendations</title><pubDate>Mon, 04 Nov 2019 02:27:35 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191639</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191639</guid><description><![CDATA[<p>page_range: 23-43</p><p>primary_author: Gornick, Marian</p><p>title: Disparities in Medicare services: Potential causes, plausible explanations, and recommendations</p><p>volume: 21</p><p>year_period: 2000 Summer</p>]]></description></item><item><title>Family members and friends who help beneficiaries make health decisions</title><pubDate>Mon, 04 Nov 2019 02:27:35 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191702</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191702</guid><description><![CDATA[<p>page_range: 105-121</p><p>primary_author: Sofaer, Shoshanna</p><p>title: Family members and friends who help beneficiaries make health decisions</p><p>volume: 23</p><p>year_period: 2001 Fall</p>]]></description></item><item><title>Assessing the RUG-III Resident Classification System for Skilled Nursing Facilities</title><pubDate>Mon, 04 Nov 2019 02:27:35 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191729</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191729</guid><description><![CDATA[<p>page_range: 7-15</p><p>primary_author: White, Chapin</p><p>title: Assessing the RUG-III Resident Classification System for Skilled Nursing Facilities</p><p>volume: 24</p><p>year_period: 2002 Winter</p>]]></description></item><item><title>Using Medicaid/SCHIP to Insure Working Families: The Massachusetts Experience</title><pubDate>Mon, 04 Nov 2019 02:27:33 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191710</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191710</guid><description><![CDATA[<p>page_range: 35-45</p><p>primary_author: Mitchell, Janet</p><p>title: Using Medicaid/SCHIP to Insure Working Families: The Massachusetts Experience</p><p>volume: 23</p><p>year_period: 2002 Spring</p>]]></description></item><item><title>Use of preventive services, beneficiary characteristics, and Medicare HMO performance.</title><pubDate>Mon, 04 Nov 2019 02:27:33 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191690</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191690</guid><description><![CDATA[<p>page_range: 141-153</p><p>primary_author: Greene, Jessica</p><p>title: Use of preventive services, beneficiary characteristics, and Medicare HMO performance.</p><p>volume: 22</p><p>year_period: 2001 Summer</p>]]></description></item><item><title>Health expenditure trends in OECD countries, 1970-1997</title><pubDate>Mon, 04 Nov 2019 02:27:33 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191620</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191620</guid><description><![CDATA[<p>page_range: 99-117</p><p>primary_author: Huber, Manfred</p><p>title: Health expenditure trends in OECD countries, 1970-1997</p><p>volume: 21</p><p>year_period: 1999 Winter</p>]]></description></item><item><title>Measuring Beneficiary Knowledge of the Medicare Program: A Psychometric Analysis</title><pubDate>Mon, 04 Nov 2019 02:27:33 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191755</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191755</guid><description><![CDATA[<p>page_range: 111-125</p><p>primary_author: Bann, Carla</p><p>title: Measuring Beneficiary Knowledge of the Medicare Program: A Psychometric Analysis</p><p>volume: 24</p><p>year_period: 2003 Summer</p>]]></description></item><item><title>Medicare hospital outpatient services and costs: implications for prospective payment.</title><pubDate>Mon, 04 Nov 2019 02:27:33 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191258</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191258</guid><description><![CDATA[<p>abstract: Medicare expenditures of hospital outpatient department (HOPD) services are growing rapidly, prompting congressional interest in a prospective payment system. In this article, the authors identify frequently provided services and examine service volume and charges in the HOPD. Relatively few services drive Medicare HOPD spending, and volume is dominated by visits, imaging and laboratory tests, whereas surgery accounts for a large proportion of charges. Hospital-level variations in charges, costs, case mix, and outliers are also explored. There is substantial variation in charges and costs across hospital types. However, after case-mix adjustment, all hospital types have average costs within 6 percent of the national average.</p><p>authors: Sulvetta, Margaret B</p><p>issue_mesh: Ambulatory Surgical Procedures/economics : Costs and Cost Analysis/statistics &#x26; numerical data : Data Collection : Diagnosis-Related Groups/economics/statistics &#x26; numerical data : Emergency Service, Hospital/economics : Fees and Charges/statistics &#x26; numerical data : Medicare/economics/statistics &#x26; numerical data : Outliers, DRG/economics/statistics &#x26; numerical data : Outpatient Clinics, Hospital/economics : Pathology Department, Hospital/economics : Prospective Payment System/economics : Radiology Department, Hospital/economics : Support, U.S. Gov't, Non-P.H.S. : United States</p><p>issue_number: 2</p><p>ntis_number: PB2001-105739</p><p>page_range: 135-149</p><p>primary_author: Miller, Mark E</p><p>title: Medicare hospital outpatient services and costs: implications for prospective payment.</p><p>volume: 14</p><p>year_period: 1992 Winter</p>]]></description></item><item><title>Home health agency benefits.</title><pubDate>Mon, 04 Nov 2019 02:27:33 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191226</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191226</guid><description><![CDATA[<p>ntis_number: PB99-106460</p><p>page_range: 125-148</p><p>primary_author: Helbing, Charles</p><p>title: Home health agency benefits.</p><p>volume: Supp.</p><p>year_period: 1992 Supp.</p>]]></description></item><item><title>Patient Selection in the ESRD Managed Care Demonstration</title><pubDate>Mon, 04 Nov 2019 02:27:33 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191749</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191749</guid><description><![CDATA[<p>page_range: 31-43</p><p>primary_author: N/A, N/A</p><p>title: Patient Selection in the ESRD Managed Care Demonstration</p><p>volume: 24</p><p>year_period: 2003 Summer</p>]]></description></item><item><title>Previous Medicaid status of children newly enrolled in supplemental security income.</title><pubDate>Mon, 04 Nov 2019 02:27:33 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191545</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191545</guid><description><![CDATA[<p>abstract: The Supplemental Security Income (SSI) program for children and adolescents has experienced a fourfold enrollment growth since 1989. Most SSI recipients also receive Medicaid, and SSI growth could therefore lead to major new Medicaid expenditures of new SSI recipients were not previous Medicaid enrollees. Using Medicaid claims for 1989-92, we determined whether SSI expansions included many children new to Medicaid as well as whether children with certain disabilities were more likely to have had Medicaid prior to SSI enrollment. Rates of new SSI enrollees without previous Medicaid coverage decreased from 53 percent in 1989 to 39 percent in 1992.</p><p>authors: Ettner, Susan L; Gortmaker, Steven L; Kuhlthau, Karen; McLaughlin, Thomas J</p><p>issue_mesh: Child : Disabled Persons : Evaluation Studies : Human : Medicaid : United States</p><p>issue_number: 4</p><p>ntis_number: PB2000-102913</p><p>page_range: 117-127</p><p>primary_author: Perrin, James M</p><p>title: Previous Medicaid status of children newly enrolled in supplemental security income.</p><p>volume: 19</p><p>year_period: 1998 Summer</p>]]></description></item><item><title>Health care indicators for the United States.</title><pubDate>Mon, 04 Nov 2019 02:27:33 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191220</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191220</guid><description><![CDATA[<p>authors: Levit, Katharine R; Maple, Brenda T</p><p>issue_mesh: Data Collection : Employment/economics/statistics &#x26; numerical data : Fees and Charges/statistics &#x26; numerical data/trends : Health Expenditures/statistics &#x26; numerical data/trends : Hospitals, Community/economics/statistics &#x26; numerical data : Inflation, Economic/statistics &#x26; numerical data/trends : Private Sector/economics : Salaries and Fringe Benefits/statistics &#x26; numerical data : United States</p><p>issue_number: 4</p><p>ntis_number: PB2001-105740</p><p>page_range: 173-199</p><p>primary_author: Donham, Carolyn S</p><p>title: Health care indicators for the United States.</p><p>volume: 13</p><p>year_period: 1992 Summer</p>]]></description></item><item><title>CMS Consumer Information Efforts</title><pubDate>Mon, 04 Nov 2019 02:27:33 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191694</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191694</guid><description><![CDATA[<p>page_range: 1-4</p><p>primary_author: Goldstein, Elizabeth</p><p>title: CMS Consumer Information Efforts</p><p>volume: 23</p><p>year_period: 2001 Fall</p>]]></description></item><item><title>Significance of Functional Status Date for Payment and Quality</title><pubDate>Mon, 04 Nov 2019 02:27:33 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191737</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191737</guid><description><![CDATA[<p>page_range: 1-12</p><p>primary_author: Clauser, Steven</p><p>title: Significance of Functional Status Date for Payment and Quality</p><p>volume: 24</p><p>year_period: 2003 Spring</p>]]></description></item><item><title>Medicaid 1915 (c) home and community-based services waivers across States.</title><pubDate>Mon, 04 Nov 2019 02:27:33 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191670</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191670</guid><description><![CDATA[<p>page_range: 159-174</p><p>primary_author: LeBlanc, Allen J</p><p>title: Medicaid 1915 (c) home and community-based services waivers across States.</p><p>volume: 22</p><p>year_period: 2000 Winter</p>]]></description></item><item><title>Post-Acute Service Use Following Acute Myocardial Infarction in the Elderly</title><pubDate>Mon, 04 Nov 2019 02:27:33 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191733</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191733</guid><description><![CDATA[<p>page_range: 77-93</p><p>primary_author: Bronskill, Susan</p><p>title: Post-Acute Service Use Following Acute Myocardial Infarction in the Elderly</p><p>volume: 24</p><p>year_period: 2002 Winter</p>]]></description></item><item><title>Factors affecting physician provision of preventive care to Medicaid children.</title><pubDate>Mon, 04 Nov 2019 02:27:33 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191684</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191684</guid><description><![CDATA[<p>page_range: 9-26</p><p>primary_author: Adams, E Kathleen</p><p>title: Factors affecting physician provision of preventive care to Medicaid children.</p><p>volume: 22</p><p>year_period: 2001 Summer</p>]]></description></item><item><title>Milestone in Medicare managed care.</title><pubDate>Mon, 04 Nov 2019 02:27:33 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191650</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191650</guid><description><![CDATA[<p>abstract: Medicare managed care has a long history, dating back to the beginning of the Medicare program. The role and prominence of managed care in Medicare have both changed over the years; though plan participation has waxed and waned, enrollment has grown steadily. The greatest growth in Medicare managed care enrollment occurred in the middle to late 1990s, coinciding with the "managed care revolution." Enrollment growth has slowed in recent years, plan participation is declining, and the future of the program is not easy to predict.</p><p>authors: N/A</p><p>issue_mesh: Managed Care Programs/economics/legislation &#x26; jurisprudence : Medicare/trends : Aged : United States : United States Health Care Financing Administration</p><p>issue_number: 1</p><p>ntis_number: PB2001-105913</p><p>page_range: 61-67</p><p>primary_author: Zarabozo, Carlos</p><p>title: Milestone in Medicare managed care.</p><p>volume: 22</p><p>year_period: 2000 Fall</p>]]></description></item><item><title>Overview of the Medicare and Medicaid programs.</title><pubDate>Mon, 04 Nov 2019 02:27:33 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191660</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191660</guid><description><![CDATA[<p>authors: Curtis, Catherine A; Klees, Barbara S</p><p>issue_mesh: Medicaid : Medicare : United States : United States Health Care Financing Administration</p><p>issue_number: 1</p><p>ntis_number: PB2001-105913</p><p>page_range: 175-193</p><p>primary_author: Hoffman Jr, Earl D</p><p>title: Overview of the Medicare and Medicaid programs.</p><p>volume: 22</p><p>year_period: 2000 Fall</p>]]></description></item><item><title>A physician's perspective on minority health</title><pubDate>Mon, 04 Nov 2019 02:27:33 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191640</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191640</guid><description><![CDATA[<p>page_range: 45-56</p><p>primary_author: Coleman-Miller, Beverly</p><p>title: A physician's perspective on minority health</p><p>volume: 21</p><p>year_period: 2000 Summer</p>]]></description></item><item><title>Hospital-based physicians: current issues and descriptive evidence.</title><pubDate>Mon, 04 Nov 2019 02:27:33 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191588</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191588</guid><description><![CDATA[<p>abstract: Hospital-based physicians (HBPs) have been the recipients of considerable attention in health policy debates in recent years. This paper discusses issues and trends concerning HBPs and presents evidence on practice characteristics, compensation methods, and incomes of anesthesiologists, pathologists, and radiologists. Some comparisons with office-based MDs are included. The primary data source is composed of physician surveys sponsored by the Health Care Financing Administration and conducted by the National Opinion Research Center in 1977 and 1978. Findings generated from these surveys support past research showing that radiology is the most lucrative HBP specialty, followed by pathology and anesthesiology; hospital-based practice tends to be considerably more lucrative than office-based practice, taken as a whole. Survey findings are discussed in light of current policy developments in the health services sector.</p><p>authors: N/A</p><p>issue_mesh: Anesthesiology/economics : Fees, Medical : Institutional Practice/economics : Insurance, Physician Services/economics : Medical Staff, Hospital/economics : Pathology/economics : Radiology/economics : Salaries and Fringe Benefits : United States</p><p>issue_number: 1</p><p>ntis_number: PB81-112823</p><p>page_range: 63-75</p><p>primary_author: Steinwald, Bruce</p><p>title: Hospital-based physicians: current issues and descriptive evidence.</p><p>volume: 2</p><p>year_period: 1980 Summer</p>]]></description></item><item><title>Implementation of risk adjustment for Medicare</title><pubDate>Mon, 04 Nov 2019 02:27:33 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191630</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191630</guid><description><![CDATA[<p>page_range: 119-126</p><p>primary_author: Ingber, Melvin J</p><p>title: Implementation of risk adjustment for Medicare</p><p>volume: 21</p><p>year_period: 2000 Spring</p>]]></description></item><item><title>Health-related quality of life predictors of survival and hospital utilization</title><pubDate>Mon, 04 Nov 2019 02:27:32 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191634</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191634</guid><description><![CDATA[<p>page_range: 171-184</p><p>primary_author: Parkerson, George R</p><p>title: Health-related quality of life predictors of survival and hospital utilization</p><p>volume: 21</p><p>year_period: 2000 Spring</p>]]></description></item><item><title>Relationships among performance measures for Medicare managed care plans.</title><pubDate>Mon, 04 Nov 2019 02:27:32 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191674</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191674</guid><description><![CDATA[<p>page_range: 23-33</p><p>primary_author: Lied, Terry R</p><p>title: Relationships among performance measures for Medicare managed care plans.</p><p>volume: 22</p><p>year_period: 2001 Spring</p>]]></description></item><item><title>Medicare managed care CAHPS: A tool for performance improvement.</title><pubDate>Mon, 04 Nov 2019 02:27:32 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191680</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191680</guid><description><![CDATA[<p>page_range: 101-107</p><p>primary_author: Goldstein, Elizabeth</p><p>title: Medicare managed care CAHPS: A tool for performance improvement.</p><p>volume: 22</p><p>year_period: 2001 Spring</p>]]></description></item><item><title>Preventing medical errors: Communicating a role for Medicare beneficiaries.</title><pubDate>Mon, 04 Nov 2019 02:27:32 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191700</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191700</guid><description><![CDATA[<p>page_range: 77-85</p><p>primary_author: Swift, Elaine K</p><p>title: Preventing medical errors: Communicating a role for Medicare beneficiaries.</p><p>volume: 23</p><p>year_period: 2001 Fall</p>]]></description></item><item><title>Growth in Residential Alternative to Nursing Homes: 2001</title><pubDate>Mon, 04 Nov 2019 02:27:32 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191757</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191757</guid><description><![CDATA[<p>page_range: 143-145</p><p>primary_author: McCormick, John</p><p>title: Growth in Residential Alternative to Nursing Homes: 2001</p><p>volume: 24</p><p>year_period: 2003 Summer</p>]]></description></item><item><title>Innovations in Section 1115 demonstrations</title><pubDate>Mon, 04 Nov 2019 02:27:32 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191664</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191664</guid><description><![CDATA[<p>page_range: 49-59</p><p>primary_author: Jordan, Joyce</p><p>title: Innovations in Section 1115 demonstrations</p><p>volume: 22</p><p>year_period: 2000 Winter</p>]]></description></item><item><title>Celebrating 35 years of Medicare and Medicaid.</title><pubDate>Mon, 04 Nov 2019 02:27:32 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191644</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191644</guid><description><![CDATA[<p>authors: N/A</p><p>issue_mesh: Medicaid : Medicare : Aged : Social Security : United States : United States Health Care Financing Administration</p><p>issue_number: 1</p><p>ntis_number: PB2001-105913</p><p>page_range: 1-7</p><p>primary_author: DeParle, Nancy A</p><p>title: Celebrating 35 years of Medicare and Medicaid.</p><p>volume: 22</p><p>year_period: 2000 Fall</p>]]></description></item><item><title>Improving the Care of ESRD Patients: A Success Story</title><pubDate>Mon, 04 Nov 2019 02:27:32 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191753</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191753</guid><description><![CDATA[<p>page_range: 89-100</p><p>primary_author: McClellan, William</p><p>title: Improving the Care of ESRD Patients: A Success Story</p><p>volume: 24</p><p>year_period: 2003 Summer</p>]]></description></item><item><title>Prescription drug coverage and spending for Medicare beneficiaries.</title><pubDate>Mon, 04 Nov 2019 02:27:32 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191565</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191565</guid><description><![CDATA[<p>abstract: Outpatient prescription drug coverage is not a Medicare covered benefit. Debate continues in Congress and elsewhere on modernizing the Medicare benefit package, including proposals that would help the Nation's seniors pay for prescription drugs. Very little is known about which persons within the Medicare population have drug coverage from other sources. Using 1995 data from the Medicare Current Beneficiary Survey (MCBS), the authors present information on who has coverage by various sociodemographic categories. The data indicate higher-than-average levels of coverage for minority persons, beneficiaries eligible for Medicare because of disability, and those with higher incomes.</p><p>authors: Chulis, George S; Cooper, Barbara S; Murray, Lauren A</p><p>issue_mesh: Adolescence : Adult : Aged : Ambulatory Care/economics : Child : Child, Preschool : Data Collection : Demography : Drug Costs/statistics &#x26; numerical data : Female : Financing, Personal/statistics &#x26; numerical data : Health Expenditures/statistics &#x26; numerical data : Health Maintenance Organizations/economics : Human : Infant : Insurance Coverage/statistics &#x26; numerical data : Insurance, Pharmaceutical Services/statistics &#x26; numerical data : Male : Medicare/economics : Rate Setting and Review</p><p>issue_number: 3</p><p>ntis_number: PB2000-102916</p><p>page_range: 15-27</p><p>primary_author: Poisal, John A</p><p>title: Prescription drug coverage and spending for Medicare beneficiaries.</p><p>volume: 20</p><p>year_period: 1999 Spring</p>]]></description></item><item><title>Linked data analysis of dually eligible beneficiaries in New England.</title><pubDate>Mon, 04 Nov 2019 02:27:32 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191562</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191562</guid><description><![CDATA[<p>abstract: Analysis of linked Medicare/Medicaid data files from four New England States (Connecticut, Maine, Massachusetts, and New Hampshire) confirm that dually eligible beneficiaries used a disproportionate amount of both Medicare and Medicaid resources in 1995, driven largely by the significant subset of the population that used institutional long-term care (LTC). If the States and the Federal Government are successful in developing approaches to dually eligible beneficiaries that reduce the use of institutional LTC, overall public costs per person could decline while Federal costs remained constant, and beneficiaries could have a greater selection of community-based options and experience greater satisfaction.</p><p>authors: Bezanson, Lee; Booth, Maureen; Bratesman Jr, Stuart; Fralich, Julie T; Gilden, Daniel; Goldstein, Elaina K; O'Connor, Darlene; Perrone, Christopher V; Willrich, Katherine K</p><p>issue_mesh: Medicaid : Medicare : Connecticut : Eligibility Determination/economics : Human : Long-Term Care/economics : Maine : Massachusetts : New Hampshire : State : United States</p><p>issue_number: 2</p><p>ntis_number: PB2000-102915</p><p>page_range: 91-108</p><p>primary_author: Saucier, Paul</p><p>title: Linked data analysis of dually eligible beneficiaries in New England.</p><p>volume: 20</p><p>year_period: 1998 Winter</p>]]></description></item><item><title>Hospital, employment, and price indicators for the health care industry: Second quarter 1999</title><pubDate>Mon, 04 Nov 2019 02:27:32 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191624</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191624</guid><description><![CDATA[<p>page_range: 239-279</p><p>primary_author: Seifert, Mary L</p><p>title: Hospital, employment, and price indicators for the health care industry: Second quarter 1999</p><p>volume: 21</p><p>year_period: 1999 Winter</p>]]></description></item><item><title>Beneficiary knowledge of the Medicare program.</title><pubDate>Mon, 04 Nov 2019 02:27:32 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191555</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191555</guid><description><![CDATA[<p>authors: Shatto, Andrew E</p><p>issue_mesh: Health Care Surveys : Knowledge, Attitudes, Practice : Aged : Attitude to Health : Health Maintenance Organizations : Human : Information Services : Insurance Benefits : Medicare/statistics &#x26; numerical data : Self Assessment (Psychology) : United States</p><p>issue_number: 1</p><p>ntis_number: PB2000-102914</p><p>page_range: 127-131</p><p>primary_author: Murray, Lauren A</p><p>title: Beneficiary knowledge of the Medicare program.</p><p>volume: 20</p><p>year_period: 1998 Fall</p>]]></description></item><item><title>What Does Voluntary Disenrollment from Medicare+Choice Plans Mean to Beneficiaries?</title><pubDate>Mon, 04 Nov 2019 02:27:32 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191724</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191724</guid><description><![CDATA[<p>page_range: 117-132</p><p>primary_author: Harris-Kojetin, Lauren</p><p>title: What Does Voluntary Disenrollment from Medicare+Choice Plans Mean to Beneficiaries?</p><p>volume: 24</p><p>year_period: 2002 Fall</p>]]></description></item><item><title>Including hospice in Medicare capitation payments: Would it save money?</title><pubDate>Mon, 04 Nov 2019 02:27:32 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191704</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191704</guid><description><![CDATA[<p>page_range: 137-147</p><p>primary_author: Riley, Gerald</p><p>title: Including hospice in Medicare capitation payments: Would it save money?</p><p>volume: 23</p><p>year_period: 2001 Fall</p>]]></description></item><item><title>Serving rural Medicare risk enrollees: HMOs' decisions, experiences, and future plans.</title><pubDate>Mon, 04 Nov 2019 02:27:32 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191553</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191553</guid><description><![CDATA[<p>abstract: This article identifies factors that influence health maintenance organizations' (HMOs) decisions about offering a Medicare risk product in rural areas; describes HMOs' recent experiences serving rural Medicare risk enrollees; and assesses the potential impact of Medicare program changes on the future willingness of HMOs to offer a Medicare risk product in rural areas. Data for the analysis were collected through interviews with a national sample of 27 HMOs. The results underscore the importance of adjusted average per capita cost (AAPCC) rates in HMOs' decisions to offer Medicare risk products in rural areas, but also indicate that other factors influence these decisions.</p><p>authors: N/A</p><p>issue_mesh: Decision Making, Organizational : Risk Sharing, Financial : Aged : Capitation Fee : Health Maintenance Organizations/economics : Human : Insurance Coverage : Medicare/economics/organization &#x26; administration : Organizational Policy : Rate Setting and Review : Rural Health Services/economics : Support, U.S. Gov't, P.H.S. : Tax Equity and Fiscal Responsibility Act : United States</p><p>issue_number: 1</p><p>ntis_number: PB2000-102914</p><p>page_range: 73-81</p><p>primary_author: Casey, Michelle</p><p>title: Serving rural Medicare risk enrollees: HMOs' decisions, experiences, and future plans.</p><p>volume: 20</p><p>year_period: 1998 Fall</p>]]></description></item><item><title>Managed care's impact on Medicaid financing for early intervention services.</title><pubDate>Mon, 04 Nov 2019 02:27:32 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191552</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191552</guid><description><![CDATA[<p>abstract: Medicaid has been a major source of financing for early intervention services since the inception of the Infants and Toddlers with Disabilities Program in 1986. In this article, the authors analyze Medicaid financing of early intervention services in 39 States before and after the introduction of managed care. The association between level of Medicaid financing and program characteristics, provider arrangements, managed care carve-out policies, and managed care contract requirements is assessed. The authors discuss the reduction of Medicaid financing after managed care and its implications for State Infants and Toddlers with Disabilities Programs, State Medicaid agencies, and managed care organizations.</p><p>authors: Almeida, Ruth A; McManus, Margaret A</p><p>issue_mesh: Disabled Children : Child, Preschool : Comparative Study : Health Services Research : Human : Infant : Insurance Coverage : Managed Care Programs/economics/organization &#x26; administration : Medicaid/organization &#x26; administration : Organizational Policy : Primary Prevention/economics : State Health Plans/economics/organization &#x26; administration : Support, U.S. Gov't, P.H.S. : United States</p><p>issue_number: 1</p><p>ntis_number: PB2000-102914</p><p>page_range: 59-72</p><p>primary_author: Fox, Harriette B</p><p>title: Managed care's impact on Medicaid financing for early intervention services.</p><p>volume: 20</p><p>year_period: 1998 Fall</p>]]></description></item><item><title>Nursing home initiative.</title><pubDate>Mon, 04 Nov 2019 02:27:32 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191654</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191654</guid><description><![CDATA[<p>abstract: Currently, 1.6 million elderly and disabled people receive care in about 17,000 nursing home across the United States. In 1987, Congress passed major nursing home reforms that defined the role of the State survey and certification process in determining the compliance of nursing homes with Federal standards. In 1998, the President announced new steps to increase Federal oversight of nursing homes' performance, collection of new fines from non-compliance homes, and an increased focus on special care areas such as nutrition, pressure sores, and abuse. HCFA responded with Nursing Home Initiative (NHI), which was intended to improve the quality of care for nursing home residents. Many of the new activities from the NHI have already been implemented, but it will take more time before we have all of them fully in operation.</p><p>authors: Feuerberg, Marvin; Miller, Patricia; Mortimore, Edward</p><p>issue_mesh: Nursing Homes/legislation &#x26; jurisprudence : Quality of Health Care : Aged : Certification : Disabled Persons : United States : United States Health Care Financing Administration</p><p>issue_number: 1</p><p>ntis_number: PB2001-105913</p><p>page_range: 113-115</p><p>primary_author: Shankroff, Jan</p><p>title: Nursing home initiative.</p><p>volume: 22</p><p>year_period: 2000 Fall</p>]]></description></item><item><title>Adjusted community rate reforms to promote HMO participation in Medicare+Choice</title><pubDate>Mon, 04 Nov 2019 02:27:31 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191608</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191608</guid><description><![CDATA[<p>page_range: 19-29</p><p>primary_author: Encinosa III, William E</p><p>title: Adjusted community rate reforms to promote HMO participation in Medicare+Choice</p><p>volume: 21</p><p>year_period: 1999 Fall</p>]]></description></item><item><title>Effect of insurance on prescription drug use by ESRD beneficiaries.</title><pubDate>Mon, 04 Nov 2019 02:27:31 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191567</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191567</guid><description><![CDATA[<p>abstract: In this article the author reviews the prescription drug coverage policy in the Medicare End Stage Renal Disease (ESRD) program and examines the relationship between secondary insurance status and the number of medications prescribed for dialysis patients who had Medicare as their primary payer. Negative binomial models were used to examine this relationship. Findings in this study indicate that the number of secondary payers has a significant impact on the number of prescription drugs received by Medicare ESRD patients. Further research is needed to determine whether Medicare beneficiaries without secondary insurance are obtaining fewer prescriptions than needed or if those with greater coverage are obtaining more than needed.</p><p>authors: N/A</p><p>issue_mesh: Insurance, Pharmaceutical Services : Adult : Aged : Demography : Dialysis : Drug Utilization/economics : Erythropoietin, Recombinant/economics/therapeutic use : Female : Health Care Financing Administration : Health Services Research : Human : Kidney Failure, Chronic/drug therapy/economics : Male : Medicare/statistics &#x26; numerical data : Middle Age : Patients/classification/statistics &#x26; numerical data : Poisson Distribution : United States</p><p>issue_number: 3</p><p>ntis_number: PB2000-102916</p><p>page_range: 39-54</p><p>primary_author: Shih, Ya C</p><p>title: Effect of insurance on prescription drug use by ESRD beneficiaries.</p><p>volume: 20</p><p>year_period: 1999 Spring</p>]]></description></item><item><title>A modular case-mix classification system for medical rehabilitation illustrated.</title><pubDate>Mon, 04 Nov 2019 02:27:31 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191512</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191512</guid><description><![CDATA[<p>abstract: The authors present a modular set of patient classification systems designed for medical rehabilitation that predict resource use and outcomes for clinically similar groups of individuals. The systems, based on the Functional Independence Measure, are referred to as Function-Related Groups (FIM-FRGs). Using data from 23,637 lower extremity fracture patients from 458 inpatient medical rehabilitation facilities, 1995 benchmarks are provided and illustrated for length of stay, functional outcome, and discharge to home and skilled nursing facilities (SNFs). The FIM-FRG modules may be used in parallel to study interactions between resource use and quality and could ultimately yield an integrated strategy for payment and outcomes measurement. This could position the rehabilitation community to take a pioneering role in the application of outcomes-based clinical indicators.</p><p>authors: Granger, Carl V</p><p>issue_mesh: Activities of Daily Living : Aged : Benchmarking : Diagnosis-Related Groups/classification : Disabled Persons : Forecasting : Health Services Research : Human : Medicare/economics/utilization : Rehabilitation Centers/economics/utilization : Rehabilitation/classification/economics : Support, U.S. Gov't, P.H.S. : United States</p><p>issue_number: 1</p><p>ntis_number: PB99-109621</p><p>page_range: 87-103</p><p>primary_author: Stineman, Margaret G</p><p>title: A modular case-mix classification system for medical rehabilitation illustrated.</p><p>volume: 19</p><p>year_period: 1997 Fall</p>]]></description></item><item><title>Reimbursement for durable medical equipment.</title><pubDate>Mon, 04 Nov 2019 02:27:31 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191598</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191598</guid><description><![CDATA[<p>abstract: The use of durable medical equipment in the home, while not a recent development, was formally recognized by the Congress with the passage of the original Medicare legislation. Since that time the statute has been amended to provide for a more workable, economical, and desirable interface among the administrative, supplier, and user communities. To assist in achieving this end, a research project was begun in October 1976 that has yielded data on Federal expenditures for reimbursement of rental and purchase costs of this equipment. Data were extracted from the Beneficiary History Files of five Part B carrier in 11 geographic areas covering the period 1976-1977. These data included the type of equipment; rental or purchase decision; submitted charges; allowed charges, and reimbursement by Medicare. Some 1.3 million individual records, from approximately 400,000 beneficiaries, were tabulated and analyzed. The exploratory nature of this research has provided a benchmark for future research and policy considerations. This article details various characteristics of the data collected for the project.</p><p>authors: Saffran, G Theodore</p><p>issue_mesh: Insurance, Health : Insurance, Health, Reimbursement : Equipment and Supplies/economics : Home Care Services/economics : Medicare/economics : United States</p><p>issue_number: 3</p><p>ntis_number: HRP0903015</p><p>page_range: 85-96</p><p>primary_author: Janssen, Theodore J</p><p>title: Reimbursement for durable medical equipment.</p><p>volume: 2</p><p>year_period: 1981 Winter</p>]]></description></item><item><title>Medicare Home Health Initiative: current activities and future directions.</title><pubDate>Mon, 04 Nov 2019 02:27:31 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191495</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191495</guid><description><![CDATA[<p>abstract: This article describes the Medicare home health benefit and summarizes the growth and change in the use of the benefit and in the industry providing home health care. The article details the progress the Home Health Initiative has achieved in the key areas of quality assurance, administration and operations, and policy. It concludes with a discussion of future directions for reforming Medicare's home health benefit.</p><p>authors: N/A</p><p>issue_mesh: Aged : Capitation Fee : Diagnosis-Related Groups : Health Care Reform : Health Care Surveys : Health Expenditures/statistics &#x26; numerical data/trends : Health Policy : Home Care Services/economics/statistics &#x26; numerical data/standards/utilization : Human : Medicare Part B/statistics &#x26; numerical data/standards/utilization : Patient Advocacy : Patient Care Planning : Prospective Payment System : Quality Assurance, Health Care : United States : United States Health Care Financing Administration</p><p>issue_number: 3</p><p>ntis_number: PB98-110554</p><p>page_range: 275-291</p><p>primary_author: Mauser, Elizabeth</p><p>title: Medicare Home Health Initiative: current activities and future directions.</p><p>volume: 18</p><p>year_period: 1997 Spring</p>]]></description></item><item><title>Evolution of Medicaid coverage of Medicare cost sharing.</title><pubDate>Mon, 04 Nov 2019 02:27:31 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191557</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191557</guid><description><![CDATA[<p>abstract: State Medicaid agencies are required to assist low-income Medicare beneficiaries to pay Medicare cost sharing, defined as premiums, deductibles, and coinsurance, as follows: all cost sharing for those below the Federal poverty level (FPL) and otherwise qualifying; Part B premiums for persons with incomes 100-120 percent of FPL; all or a portion Part B premiums for persons 120-175 percent of FPL, limited by funding availability; Part A premiums for persons with disabilities who have worked their way off Social Security and whose incomes are below 200 percent of FPL. States also have the option to extend additional protections or to cover additional Medicare beneficiaries beyond what is mandated by Federal law. Obviously, Federal changes in Medicare may have profound, if not always anticipated, implications for Medicaid. Understanding how current policy on dually eligible beneficiaries came into being may help shape what it will become.</p><p>authors: N/A</p><p>issue_mesh: Cost Sharing : Disabled Persons : Eligibility Determination : Human : Medicaid : Medicare : Social Security/legislation &#x26; jurisprudence : United States</p><p>issue_number: 2</p><p>ntis_number: PB2000-102915</p><p>page_range: 11-18</p><p>primary_author: Carpenter, Letty</p><p>title: Evolution of Medicaid coverage of Medicare cost sharing.</p><p>volume: 20</p><p>year_period: 1998 Winter</p>]]></description></item><item><title>Vulnerability of rural hospitals to Medicare outpatient payment reform</title><pubDate>Mon, 04 Nov 2019 02:27:31 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191607</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191607</guid><description><![CDATA[<p>page_range: 1-18</p><p>primary_author: Mohr, Penny E</p><p>title: Vulnerability of rural hospitals to Medicare outpatient payment reform</p><p>volume: 21</p><p>year_period: 1999 Fall</p>]]></description></item><item><title>Achieving Improvement Through Nursing Home Quality Measurement</title><pubDate>Mon, 04 Nov 2019 02:27:31 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191714</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191714</guid><description><![CDATA[<p>page_range: 5-18</p><p>primary_author: Harris, Yael</p><p>title: Achieving Improvement Through Nursing Home Quality Measurement</p><p>volume: 23</p><p>year_period: 2002 Summer</p>]]></description></item><item><title>Matching health policy with data: Data and analytic requirements for Federal policymakers</title><pubDate>Mon, 04 Nov 2019 02:27:31 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191615</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191615</guid><description><![CDATA[<p>page_range: 15-23</p><p>primary_author: Thorpe, Kenneth E</p><p>title: Matching health policy with data: Data and analytic requirements for Federal policymakers</p><p>volume: 21</p><p>year_period: 1999 Winter</p>]]></description></item><item><title>Evaluating alternative risk adjusters for Medicare.</title><pubDate>Mon, 04 Nov 2019 02:27:31 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191563</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191563</guid><description><![CDATA[<p>abstract: In this study the authors use 3 years of the Medicare Current Beneficiary Survey (MCBS) to evaluate alternative demographic, survey, and claims-based risk adjusters for Medicare capitation payment. The survey health-status models have three to four times the predictive power of the demographic models. The risk-adjustment model derived from claims diagnoses have 75-percent greater predictive power than a comprehensive survey model. No single model predicts average expenditures well for all beneficiary subgroups of interest, suggesting a combined model may be appropriate. More data are needed to obtain stable estimates of model parameters. Advantages and disadvantages of alternative risk adjusters are discussed.</p><p>authors: Adamache, Killard W; Khandker, Rezaul K; Walsh, Edith G</p><p>issue_mesh: Managed Care Programs : Medicare : Aged : Economics, Medical : Health Services Research/economics : Health Surveys : Human : Models, Econometric : Patient Satisfaction : Regression Analysis : Support, U.S. Gov't, Non-P.H.S. : United States</p><p>issue_number: 2</p><p>ntis_number: PB2000-102915</p><p>page_range: 109-129</p><p>primary_author: Pope, Gregory C</p><p>title: Evaluating alternative risk adjusters for Medicare.</p><p>volume: 20</p><p>year_period: 1998 Winter</p>]]></description></item><item><title>Different data systems, different conclusions? Comparing hospital use data for the aged from four data systems.</title><pubDate>Mon, 04 Nov 2019 02:27:31 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191603</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191603</guid><description><![CDATA[<p>abstract: Four major national data systems collect data on short-stay hospital use by persons age 65 years and over. This paper examines the extent of agreement on the major statistics reported from the four systems and explains, as far as possible, the reasons for discrepancies among the data. The paper also offers some suggestions to the user of hospital care data. The study shows that for national trends the four systems agreed on number of admissions, average length of stay, and days of care. Comparisons across census regions revealed agreement on average length of stay, but showed an unanticipated lack of agreement on admissions. When we examined data on admissions and average length of stay by diagnosis and surgical procedure groups there was agreement among the data systems for most groups, but for certain groups wide differences occurred. The results emphasize the need for data users to understand the nature and limitations of the data they employ. The results also point to a need for data users to consult a number of sources whenever possible.</p><p>authors: N/A</p><p>issue_mesh: Aged : Information Systems : Comparative Study : Data Collection : Hospitals/utilization : Human : Length of Stay : Patient Admission : United States</p><p>issue_number: 4</p><p>ntis_number: PB82-130154</p><p>page_range: 41-60</p><p>primary_author: Lubitz, James</p><p>title: Different data systems, different conclusions? Comparing hospital use data for the aged from four data systems.</p><p>volume: 2</p><p>year_period: 1981 Spring</p>]]></description></item><item><title>Impact of the Maine Medicaid waiver for the mentally retarded.</title><pubDate>Mon, 04 Nov 2019 02:27:31 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191093</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191093</guid><description><![CDATA[<p>abstract: To evaluate the impact of Maine's Medicaid waiver for the mentally retarded, baseline and 1-year followup data were obtained for 191 waiver clients and a comparison population of 115 persons excluded from the program because of enrollment limits. Program effectiveness was evaluated through measures of changes in clients' personal and community living skills. Medicaid and other data were used to establish individual and aggregate costs. It was found that the waiver program is a cost-effective alternative to intermediate care placements but that client screening is necessary to limit the enrollment of clients not at risk of institutional placement.</p><p>authors: Adler, Gerald S; Fortinsky, Richard H; Kilbreth, Elizabeth H; McGuire, Catherine A</p><p>issue_mesh: Community Mental Health Services/economics : Cost Control/methods : Data Collection : Evaluation Studies : Female : Human : Maine : Male : Medicaid/organization &#x26; administration : Mental Retardation/economics : Multivariate Analysis : Program Evaluation/statistics &#x26; numerical data : Support, U.S. Gov't, Non-P.H.S. : United States</p><p>issue_number: 3</p><p>ntis_number: PB90-258153</p><p>page_range: 43-50</p><p>primary_author: Coburn, Andrew F</p><p>title: Impact of the Maine Medicaid waiver for the mentally retarded.</p><p>volume: 11</p><p>year_period: 1990 Spring</p>]]></description></item><item><title>Social/health maintenance organization and fee-for-service health outcomes over time.</title><pubDate>Mon, 04 Nov 2019 02:27:31 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191306</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191306</guid><description><![CDATA[<p>abstract: Evaluating the performance of long-term care (LTC) demonstrations requires longitudinal assessment of multiple outcomes where selective mortality and disenrollment, if not accounted for, can give the appearance of reduced (or enhanced) efficacy. We assessed outcomes in social/health maintenance organizations (S/HMOs) and Medicare fee-for-service (FFS) care using a multivariate model to estimate active life expectancy (ALE). S/HMO enrollees and samples of FFS clients in four sites were analyzed and outcome differences assessed for a 3-year period. Results provide insights into S/HMO performance under different conditions and, more generally, into evaluating LTC demonstrations without randomized client and control groups.</p><p>authors: Harrington, Charlene; Lowrimore, Gene R; Newcomer, Robert; Vertrees, James C</p><p>issue_mesh: Treatment Outcome : Activities of Daily Living : Aged : Capitation Fee/standards : Comparative Study : Cost-Benefit Analysis : Diagnosis-Related Groups/statistics &#x26; numerical data : Fees, Medical/statistics &#x26; numerical data : Female : Health Maintenance Organizations/economics/statistics &#x26; numerical data : Health Services for the Aged/economics/statistics &#x26; numerical data : Health Services Research : Human : Insurance, Health, Reimbursement : Life Expectancy : Long-Term Care/economics/statistics &#x26; numerical data : Male : Medicare/economics/statistics &#x26; numerical data : Models, Statistical : Mortality : Support, U.S. Gov't, Non-P.H.S. : United States</p><p>issue_number: 2</p><p>ntis_number: PB95-123469</p><p>page_range: 173-202</p><p>primary_author: Manton, Kenneth G</p><p>title: Social/health maintenance organization and fee-for-service health outcomes over time.</p><p>volume: 15</p><p>year_period: 1993 Winter</p>]]></description></item><item><title>Potential Organ-Donor Supply and Efficiency of Organ Procurement Organizations</title><pubDate>Mon, 04 Nov 2019 02:27:31 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191754</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191754</guid><description><![CDATA[<p>page_range: 101-110</p><p>primary_author: Guadagnoli, Edward</p><p>title: Potential Organ-Donor Supply and Efficiency of Organ Procurement Organizations</p><p>volume: 24</p><p>year_period: 2003 Summer</p>]]></description></item><item><title>Inpatient transfer episodes among aged Medicare beneficiaries.</title><pubDate>Mon, 04 Nov 2019 02:27:31 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191300</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191300</guid><description><![CDATA[<p>abstract: Examination of data derived from Medicare provider analysis and review (MEDPAR) discharge records for 152,337 transfer episodes of aged Medicare beneficiaries indicates that aged Medicare transfer patients have initial stays comparable to non-transfers in terms of length of stay, case-mix intensity, and total charges. During the final part of the transfer episode, however, transfers are clearly more intense cases than non-transfers. Patients treated for stroke or cardiovascular conditions are more likely to be transferred than other Medicare aged inpatients. The transfer episodes examined appear to reflect clinical considerations based primarily on patient need for specialized care.</p><p>authors: N/A</p><p>issue_mesh: Aged : Data Collection : Diagnosis-Related Groups/statistics &#x26; numerical data : Episode of Care : Health Services Research : Hospital Costs/statistics &#x26; numerical data : Hospitals, Teaching/economics/utilization : Hospitals/statistics &#x26; numerical data/utilization : Human : Length of Stay/economics/statistics &#x26; numerical data : Medicare Part A/statistics &#x26; numerical data : Outliers, DRG/statistics &#x26; numerical data : Patient Transfer/economics/statistics &#x26; numerical data : Prospective Payment System/economics/statistics &#x26; numerical data : United States</p><p>issue_number: 2</p><p>ntis_number: PB95-123469</p><p>page_range: 71-87</p><p>primary_author: Buczko, William</p><p>title: Inpatient transfer episodes among aged Medicare beneficiaries.</p><p>volume: 15</p><p>year_period: 1993 Winter</p>]]></description></item><item><title>An Assessment Tool Translation Study</title><pubDate>Mon, 04 Nov 2019 02:27:31 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191740</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191740</guid><description><![CDATA[<p>page_range: 45-60</p><p>primary_author: Buchanan, Joan</p><p>title: An Assessment Tool Translation Study</p><p>volume: 24</p><p>year_period: 2003 Spring</p>]]></description></item><item><title>How do Medicare physician fees compare with private payers?</title><pubDate>Mon, 04 Nov 2019 02:27:31 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191264</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191264</guid><description><![CDATA[<p>abstract: Under the new fee schedule, Medicare physician fees are 76 percent of private fees. Consistent with the intent of payment reform, Medicare physician fees more closely approximate private fees for visits (93 percent) than for surgery (51 percent) and in rural areas as compared with large metropolitan areas. Variation in private fees across the country is considerably greater than it is for Medicare fees. Consequently, Medicare fees are most generous in areas that compare least favorably with the private market because private fees in these areas are well above average. These results shed light on the impact of the fee schedule and on the implications of using Medicare payment methods as part of a broad-based health reform.</p><p>authors: Gates, Michael; Zuckerman, Stephen</p><p>issue_mesh: Comparative Study : Data Interpretation, Statistical : Fee Schedules/statistics &#x26; numerical data : Fees, Medical/statistics &#x26; numerical data : Geography : Insurance, Physician Services/economics : Medicare Part B/economics : Private Sector/economics : Professional Practice Location/economics : Support, U.S. Gov't, Non-P.H.S. : United States</p><p>issue_number: 3</p><p>ntis_number: PB95-111274</p><p>page_range: 25-39</p><p>primary_author: Miller, Mark E</p><p>title: How do Medicare physician fees compare with private payers?</p><p>volume: 14</p><p>year_period: 1993 Spring</p>]]></description></item><item><title>Adjusted Clinical Groups: Predictive Accuracy for Medicaid Enrollees I Three States</title><pubDate>Mon, 04 Nov 2019 02:27:31 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191720</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191720</guid><description><![CDATA[<p>page_range: 43-60</p><p>primary_author: Adams, Kathleen</p><p>title: Adjusted Clinical Groups: Predictive Accuracy for Medicaid Enrollees I Three States</p><p>volume: 24</p><p>year_period: 2002 Fall</p>]]></description></item><item><title>Expansion of Medicare's Definition of Post-Acute Care Transfers</title><pubDate>Mon, 04 Nov 2019 02:27:31 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191734</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191734</guid><description><![CDATA[<p>page_range: 95-113</p><p>primary_author: Cromwell, Jerry</p><p>title: Expansion of Medicare's Definition of Post-Acute Care Transfers</p><p>volume: 24</p><p>year_period: 2002 Winter</p>]]></description></item><item><title>Ambulatory and community-based services</title><pubDate>Mon, 04 Nov 2019 02:27:31 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191573</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191573</guid><description><![CDATA[<p>issue_number: 4</p><p>ntis_number: PB2000-102444</p><p>page_range: 1-6</p><p>primary_author: Thomas, Fred</p><p>title: Ambulatory and community-based services</p><p>volume: 20</p><p>year_period: 1999 Summer</p>]]></description></item><item><title>Quality of ambulatory care for the elderly: formulating evaluation criteria.</title><pubDate>Mon, 04 Nov 2019 02:27:30 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191134</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191134</guid><description><![CDATA[<p>abstract: Efforts to assess the quality of ambulatory care services provided to Medicare beneficiaries cannot meaningfully proceed unless a concerted effort is made to develop criteria and standards for ambulatory care quality assessment that reflect the specific characteristics and needs of the elderly. In this article, we describe some of those characteristics and needs--such as physical and mental impairments and multiple coexisting conditions--and we show how they affect the care provided to the elderly and, therefore, the proper assessment of that care. We also outline an approach for the orderly development of the requisite criteria and standards.</p><p>authors: Wyszewianski, Leon</p><p>issue_mesh: Aged : Ambulatory Care/standards : Evaluation Studies : Geriatric Assessment : Health Services for the Aged/standards : Human : Medicare/standards : Outcome and Process Assessment (Health Care)/standards : Quality of Health Care/standards : United States</p><p>issue_number: 1</p><p>ntis_number: PB91-176255</p><p>page_range: 31-38</p><p>primary_author: Ferris, Ann K</p><p>title: Quality of ambulatory care for the elderly: formulating evaluation criteria.</p><p>volume: 12</p><p>year_period: 1990 Fall</p>]]></description></item><item><title>Medicare fee-for-service issues and innovations.</title><pubDate>Mon, 04 Nov 2019 02:27:30 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191507</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191507</guid><description><![CDATA[<p>authors: N/A</p><p>issue_mesh: Aged : Cost Sharing : Economic Competition : Fee-for-Service Plans/trends : Human : Managed Care Programs/economics : Medicare Part B/legislation &#x26; jurisprudence : United States : United States Health Care Financing Administration</p><p>issue_number: 1</p><p>ntis_number: PB99-109621</p><p>page_range: 1-4</p><p>primary_author: Cotterill, Philip G</p><p>title: Medicare fee-for-service issues and innovations.</p><p>volume: 19</p><p>year_period: 1997 Fall</p>]]></description></item><item><title>State initiatives for the medically uninsured.</title><pubDate>Mon, 04 Nov 2019 02:27:30 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191128</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191128</guid><description><![CDATA[<p>ntis_number: PB91-176248</p><p>page_range: 161-166</p><p>primary_author: Merrill, Jeffrey C</p><p>title: State initiatives for the medically uninsured.</p><p>volume: Supp.</p><p>year_period: 1990 Supp.</p>]]></description></item><item><title>Hospital, employment, and price indicators for the health care industry: First quarter 1999</title><pubDate>Mon, 04 Nov 2019 02:27:30 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191612</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191612</guid><description><![CDATA[<p>page_range: 79-121</p><p>primary_author: Seifert, Mary L</p><p>title: Hospital, employment, and price indicators for the health care industry: First quarter 1999</p><p>volume: 21</p><p>year_period: 1999 Fall</p>]]></description></item><item><title>Outcomes of surgery under Medicaid.</title><pubDate>Mon, 04 Nov 2019 02:27:30 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191090</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191090</guid><description><![CDATA[<p>abstract: In this study, health outcomes during the 6-month period following surgery are examined for all Medicaid recipients in Michigan and Georgia who underwent selected surgical procedures between July 1, 1981, and June 30, 1982. Readmissions were somewhat more prevalent in both States for hysterectomy, cholecystectomy, appendectomy, and myringotomy. On almost all measures in both States, levels of post-surgical utilization, expenditure, and complications were higher among females, older patients, Supplemental Security Income enrollees, and those with higher levels of presurgical utilization and longer and more costly surgical stays. The results further demonstrate the utility of claims data in monitoring outcomes of surgery.</p><p>authors: Pine, Penelope L; Simon, James</p><p>issue_mesh: Data Collection : Evaluation Studies : Female : Georgia/epidemiology : Health Expenditures/statistics &#x26; numerical data : Human : Male : Medicaid/statistics &#x26; numerical data : Michigan/epidemiology : Outcome and Process Assessment (Health Care)/methods : Patient Readmission/statistics &#x26; numerical data : Research Design : Surgical Procedures, Operative/adverse effects/utilization : United States</p><p>issue_number: 3</p><p>ntis_number: PB90-258153</p><p>page_range: 1-16</p><p>primary_author: Klingman, David</p><p>title: Outcomes of surgery under Medicaid.</p><p>volume: 11</p><p>year_period: 1990 Spring</p>]]></description></item><item><title>Evaluation of the Medicaid competition demonstrations.</title><pubDate>Mon, 04 Nov 2019 02:27:30 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191086</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191086</guid><description><![CDATA[<p>abstract: In 1983, the Health Care Financing Administration funded a multiyear evaluation of Medicaid demonstrations in six States. The alternative delivery systems represented by the demonstrations contained a number of innovative features, most notably capitation, case management, limitations on provider choice, and provider competition. Implementation and operation issues as well as demonstration effects on utilization and cost of care, administrative costs, rate setting, biased selection, quality of care, and access and satisfaction were evaluated. Both primary and secondary data sources were used in the evaluation. This article contains an overview and summary of evaluation findings on the effects of the demonstrations.</p><p>authors: Carey, Timothy S; Fox, Peter D; Hurley, Robert E; Meyer, Jack A; Paul, John E; Rossiter, Louis F</p><p>issue_mesh: Health Services Research : California : Capitation Fee : Consumer Satisfaction : Costs and Cost Analysis : Evaluation Studies : Florida : Managed Care Programs/utilization : Medicaid/organization &#x26; administration : Minnesota : Missouri : New Jersey : New York : Quality of Health Care : Statistics : Support, U.S. Gov't, Non-P.H.S. : United States : United States Health Care Financing Administration</p><p>issue_number: 2</p><p>ntis_number: PB90-204629</p><p>page_range: 81-97</p><p>primary_author: Freund, Deborah A</p><p>title: Evaluation of the Medicaid competition demonstrations.</p><p>volume: 11</p><p>year_period: 1989 Winter</p>]]></description></item><item><title>Equal treatment and unequal benefits: a re-examination of the use of Medicare services by race, 1967-1976.</title><pubDate>Mon, 04 Nov 2019 02:27:30 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191597</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191597</guid><description><![CDATA[<p>abstract: In the early years of the Medicare program, proportionally more whites than non-whites among the aged used Medicare services. This article examines the use and reimbursement of Medicare services by the aged between 1967 and 1976 to determine if racial differences still exist. To do so, three measures are studied. The first, the number of persons reimbursed for Medicare service per 1,000 enrollees, measures access to Medicare's reimbursement system. The second, reimbursement per person using reimbursed services, measures the amount of reimbursement received after persons exceed Medicare deductibles. The third, reimbursement per enrollee, indicates the combined effect of access and reimbursement and represents a measure of equity for the population at risk. Analysis of the three measures by type of Medicare service found that the disparities in use and reimbursement of services by race decreased considerably between 1967 and 1976. This trend was found both at the national and at the regional level. Overall, the decreases in the disparity measured are note-worthy. By type of service, proportionally more whites than non-whites still receive reimbursement. However, once non-whites exceed deductibles, the reimbursements per person using reimbursed services are generally comparable or higher than reimbursement to whites.</p><p>authors: Dobson, Allen</p><p>issue_mesh: Minority Groups : Whites : Human : Insurance, Health, Reimbursement : Medicare/utilization : United States</p><p>issue_number: 3</p><p>ntis_number: HRP0903015</p><p>page_range: 55-83</p><p>primary_author: Ruther, Martin M</p><p>title: Equal treatment and unequal benefits: a re-examination of the use of Medicare services by race, 1967-1976.</p><p>volume: 2</p><p>year_period: 1981 Winter</p>]]></description></item><item><title>Nursing home levels of care: reimbursement of resident specific costs.</title><pubDate>Mon, 04 Nov 2019 02:27:30 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191592</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191592</guid><description><![CDATA[<p>abstract: The companion paper on nursing home levels of care (Bishop, Plough and Willemain, 1980) recommended a "split-rate" approach to nursing home reimbursement that would distinguish between fixed and variable costs. This paper examines three alternative treatments of the variable cost component of the rate: a two-level system similar to the distinction between skilled and intermediate care facilities, an individualized ("patient-centered") system, and a system that assigns a single facility-specific rate that depends on the facility's case-mix ("case-mix reimbursement"). The aim is to better understand the theoretical strengths and weaknesses of these three approaches. The comparison of reimbursement alternatives is framed in terms of minimizing reimbursement error, meaning overpayment and underpayment. We develop a conceptual model of reimbursement error that stresses that the features of the reimbursement scheme are only some of the factors contributing to over- and underpayment. The conceptual model is translated into a computer program for quantitative comparison of the alternatives.</p><p>authors: N/A</p><p>issue_mesh: Reimbursement Mechanisms : Medicaid/economics : Nursing Homes/classification : Patients/classification : United States</p><p>issue_number: 2</p><p>ntis_number: HRP-0902942</p><p>page_range: 47-52</p><p>primary_author: Willemain, Thomas R</p><p>title: Nursing home levels of care: reimbursement of resident specific costs.</p><p>volume: 2</p><p>year_period: 1980 Fall</p>]]></description></item><item><title>Assessment of the effectiveness of supply-side cost-containment measures</title><pubDate>Mon, 04 Nov 2019 02:27:30 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191176</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191176</guid><description><![CDATA[<p>ntis_number: PB99-106478</p><p>page_range: 13-21</p><p>primary_author: Garrison Jr, Louis P</p><p>title: Assessment of the effectiveness of supply-side cost-containment measures</p><p>volume: Supp.</p><p>year_period: 1991 Supp.</p>]]></description></item><item><title>Cost of smoking to the Medicare program, 1993</title><pubDate>Mon, 04 Nov 2019 02:27:30 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191583</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191583</guid><description><![CDATA[<p>abstract: Medicare expenditures attributable to smoking in 1993 were estimated using a multivariate model that related expenditures to smoking history, health status, and the propensity to have had a smoking-related disease, controlling for sociodemographics, economic variables, and other risk factors. Smoking-attributable Medicare expenditures are presented separately for each State and by type of expenditure. Nationally, smoking accounted for 9.4 percent of Medicare expenditures $14.2 billion, with considerable variation among States. Smoking accounted for 11.4 percent of Medicare expenditures for hospital care, 11.3 percent of nursing home care, 5.9 percent of home health care, and 5.6 percent of ambulatory care.</p><p>authors: Max, Wendy; Miller, Leonard; Rice, Dorothy P</p><p>issue_mesh: Costs and Cost Analysis : Medicare : Health Expenditures : Multivariate Analysis : Statistics : United States</p><p>issue_number: 4</p><p>ntis_number: PB2000-102444</p><p>page_range: 179-196</p><p>primary_author: Zhang, Xiulan</p><p>title: Cost of smoking to the Medicare program, 1993</p><p>volume: 20</p><p>year_period: 1999 Summer</p>]]></description></item><item><title>Measuring geographic variations in hospitals' capital costs.</title><pubDate>Mon, 04 Nov 2019 02:27:30 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191170</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191170</guid><description><![CDATA[<p>abstract: The Health Care Financing Administration (HCFA) has proposed incorporating hospital capital payments into the Medicare prospective payment system. HCFA's proposal includes an adjustment to capital payments for geographic differences in capital costs, derived from the prospective payment system area hospital wage index. Alternatively, the geographic adjustment could be based on an area construction cost index. Geographic construction cost indexes calculated from the cost per square foot of finished structures or from construction labor and materials input prices are evaluated in this article.</p><p>authors: N/A</p><p>issue_mesh: Abstracting and Indexing/economics : Capital Expenditures/classification : Costs and Cost Analysis/classification : Evaluation Studies : Financial Management, Hospital/legislation &#x26; jurisprudence : Financing, Construction/classification : Geography : Medicare Part A/legislation &#x26; jurisprudence : Prospective Payment System/classification : Support, U.S. Gov't, Non-P.H.S. : United States : United States Health Care Financing Administration</p><p>issue_number: 4</p><p>ntis_number: PB2001-105731</p><p>page_range: 75-86</p><p>primary_author: Pope, Gregory C</p><p>title: Measuring geographic variations in hospitals' capital costs.</p><p>volume: 12</p><p>year_period: 1991 Summer</p>]]></description></item><item><title>Revisions to the National Health Accounts and methodology.</title><pubDate>Mon, 04 Nov 2019 02:27:30 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191102</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191102</guid><description><![CDATA[<p>authors: Blank, Loius A; Brown, Aaron P; Cowan, Cathy A; Donham, Carolyn S; Freeland, Mark S; Lazenby, Helen C; Letsch, Suzanne W; Levit, Katharine R; Maple, Brenda T</p><p>issue_mesh: Data Collection/methods : Economics, Hospital/statistics &#x26; numerical data : Economics, Medical/statistics &#x26; numerical data : Health Expenditures/statistics &#x26; numerical data : Research Design : United States</p><p>issue_number: 4</p><p>ntis_number: PB91-105973</p><p>page_range: 42-54</p><p>primary_author: Arnett 3d, Ross H</p><p>title: Revisions to the National Health Accounts and methodology.</p><p>volume: 11</p><p>year_period: 1990 Summer</p>]]></description></item><item><title>Overview: Measuring health spending</title><pubDate>Mon, 04 Nov 2019 02:27:30 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191613</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191613</guid><description><![CDATA[<p>page_range: 1-3</p><p>primary_author: Waldo, Daniel R</p><p>title: Overview: Measuring health spending</p><p>volume: 21</p><p>year_period: 1999 Winter</p>]]></description></item><item><title>Expenditures for mental health services in the Utah Prepaid Mental Health Plan.</title><pubDate>Mon, 04 Nov 2019 02:27:30 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191485</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191485</guid><description><![CDATA[<p>abstract: This article examines the effect of a mental health carve-out, the Utah Prepaid Mental Health Plan (UPMHP), on expenditures for mental health treatment and utilization of mental health services for Medicaid beneficiaries from July 1991 through December 1994. Three Community Mental Health Centers (CMHCs) provided mental health services to Medicaid beneficiaries in their catchment areas in return for capitated payments. The analysis uses data from Medicaid claims as well as "shadow claims" for UPMHP contracting sites. The analysis is a pre/post comparison of expenditures and utilization rates, with a contemporaneous control group in the Utah catchment areas not in the UPMHP. The results indicate that the UPMHP reduced acute inpatient mental health expenditures and admissions for Medicaid beneficiaries during the first 2 1/2 years of the UPMHP. In contrast, the UPMHP had no statistically significant effect on outpatient mental health expenditures or visits. There was no significant effect of the UPMHP on overall mental health expenditures.</p><p>authors: Christianson, Jon B; Gray, Donald Z; Manning Jr, Willard G; Marriott, Sally</p><p>issue_mesh: Capitation Fee : Catchment Area (Health) : Costs and Cost Analysis : Fee-for-Service Plans : Health Care Surveys : Health Expenditures/statistics &#x26; numerical data : Medicaid/statistics &#x26; numerical data/utilization : Mental Health Services/economics/utilization : Prepaid Health Plans/economics : State Health Plans/economics : Support, Non-U.S. Gov't : Support, U.S. Gov't, P.H.S. : United States : Utah</p><p>issue_number: 3</p><p>ntis_number: PB98-110554</p><p>page_range: 73-93</p><p>primary_author: Stoner, Tamara</p><p>title: Expenditures for mental health services in the Utah Prepaid Mental Health Plan.</p><p>volume: 18</p><p>year_period: 1997 Spring</p>]]></description></item><item><title>Long-term care eligibility criteria for People with Alzheimer s disease</title><pubDate>Mon, 04 Nov 2019 02:27:30 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191577</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191577</guid><description><![CDATA[<p>abstract: Long-term care (LTC) eligibility criteria are applied to a sample of 8,437 people with dementia enrolled in the Medicare Alzheimer's Disease Demonstration. The authors find that mental-status-test cutoff points substantially affect the pool of potential beneficiaries. Functional criteria alone leave out people with relatively severe dementia and with behavioral problems. It is therefore important to consider both behavioral and mental-status-test criteria in establishing eligibility for community-based services for people with dementia.</p><p>authors: Maslow, Katie; Zhang, Xiulan</p><p>issue_mesh: Alzheimer Disease : Program Evaluation : Aged : Community Health Services : Long-Term Care : Medicare : Support, U.S. Gov't, non-P.H.S. : United States</p><p>issue_number: 4</p><p>ntis_number: PB2000-102444</p><p>page_range: 67-85</p><p>primary_author: Fox, Patrick</p><p>title: Long-term care eligibility criteria for People with Alzheimer s disease</p><p>volume: 20</p><p>year_period: 1999 Summer</p>]]></description></item><item><title>Case management, client risk factors and service use.</title><pubDate>Mon, 04 Nov 2019 02:27:30 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191513</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191513</guid><description><![CDATA[<p>abstract: Six "pure" types of case-manager activity are identified using chart data from 922 cases in the Medicare Alzheimer's Disease Demonstration. The association between case-manager actions and client characteristics, and between case-manager activities and service use outcomes is used to test predictive validity. Case-manager activity is generally more associated with caregiver than client characteristics. Monitoring and service management was protective against nursing home placement. A clinical nursing emphasis was protective against hospitalization. Understanding how case management is differentiated may improve staffing, treatment protocol, and client service outcomes.</p><p>authors: Arnsberger, Pamela; Zhang, Xiulan</p><p>issue_mesh: Aged : Alzheimer Disease/economics : Case Management/organization &#x26; administration : Continuity of Patient Care : Female : Health Resources/utilization : Health Services Research : Home Care Services/organization &#x26; administration/utilization : Human : Male : Medicare/economics/organization &#x26; administration : Models, Organizational : Pilot Projects : Support, U.S. Gov't, P.H.S. : United States</p><p>issue_number: 1</p><p>ntis_number: PB99-109621</p><p>page_range: 105-120</p><p>primary_author: Newcomer, Robert</p><p>title: Case management, client risk factors and service use.</p><p>volume: 19</p><p>year_period: 1997 Fall</p>]]></description></item><item><title>Hospital, employment, and price indicators for the health care industry: fourth quarter 1996 and annual data for 1988-96.</title><pubDate>Mon, 04 Nov 2019 02:27:30 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191505</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191505</guid><description><![CDATA[<p>abstract: This regular feature of the journal includes a discussion of each of the following four topics: community hospital statistics; employment, hours, and earnings in the private health sector; health care prices; and national economic indicators. These statistics are valuable in their own right for understanding the relationship between the health care sector and the overall economy. In addition, they allow us to anticipate the direction and magnitude of health care cost changes prior to the availability of more comprehensive data.</p><p>authors: Donham, Carolyn S; Heffler, Stephen K</p><p>issue_mesh: Data Collection : Employment/statistics &#x26; numerical data/trends : Fees, Medical/statistics &#x26; numerical data/trends : Forecasting : Health Expenditures/statistics &#x26; numerical data/trends : Health Personnel : Hospitals, Community/economics/statistics &#x26; numerical data/utilization : Medicare : Salaries and Fringe Benefits/statistics &#x26; numerical data/trends : United States</p><p>issue_number: 4</p><p>ntis_number: PB99-109613</p><p>page_range: 133-175</p><p>primary_author: Sensenig, Arthur L</p><p>title: Hospital, employment, and price indicators for the health care industry: fourth quarter 1996 and annual data for 1988-96.</p><p>volume: 18</p><p>year_period: 1997 Summer</p>]]></description></item><item><title>National health expenditures, 1979.</title><pubDate>Mon, 04 Nov 2019 02:27:30 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191585</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191585</guid><description><![CDATA[<p>abstract: Outlays for health care in the nation reached $212.2 billion in calendar year 1979--12.5 percent higher than in 1978, according to preliminary figures compiled by the Health Care Financing Administration. This estimate represented $943 per person in the United States and was equal to 9.0 percent of the Gross National Product. This latest report in the annual series representing national health expenditures provides detailed estimates of health care spending by type of service and method of financing.</p><p>authors: N/A</p><p>issue_mesh: Delivery of Health Care/economics : Health Expenditures/trends : Insurance, Health, Reimbursement/economics : Personal Health Services/economics : Statistics : United States</p><p>issue_number: 1</p><p>ntis_number: PB81-112823</p><p>page_range: 1-36</p><p>primary_author: Gibson, Robert M</p><p>title: National health expenditures, 1979.</p><p>volume: 2</p><p>year_period: 1980 Summer</p>]]></description></item><item><title>Trends in use, cost, and outcomes of human recombinant erythropoietin, 1989-98.</title><pubDate>Mon, 04 Nov 2019 02:27:29 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191568</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191568</guid><description><![CDATA[<p>abstract: In this article the authors present descriptive data showing trends in human recombinant erythropoietin (EPO) doses, charges, and patient hematocrits from the fourth quarter of calendar year 1989 to the first quarter of 1998 for all recipients and recent data for patients treated by in-center hemodialysis. In 1997 nearly all in-center hemodialysis patients received EPO regularly at an average cost per recipient of $6,245 per year for total allowed charges of $842.2 million per year. The study shows that policy changes may have both anticipated and unanticipated effects on medical practice.</p><p>authors: Eggers, Paul W; Milam, Roger A</p><p>issue_mesh: Drug Utilization Review : Anemia/drug therapy/etiology : Erythropoietin, Recombinant/administration &#x26; dosage/economics : Hemodialysis Units, Hospital/economics : Human : Insurance, Health, Reimbursement/statistics &#x26; numerical data : Insurance, Pharmaceutical Services/statistics &#x26; numerical data : Kidney Failure, Chronic/therapy : Medicare/statistics &#x26; numerical data : Treatment Outcome : United States : United States Health Care Financing Administration</p><p>issue_number: 3</p><p>ntis_number: PB2000-102916</p><p>page_range: 55-62</p><p>primary_author: Greer, Joel W</p><p>title: Trends in use, cost, and outcomes of human recombinant erythropoietin, 1989-98.</p><p>volume: 20</p><p>year_period: 1999 Spring</p>]]></description></item><item><title>Five most commonly used types of pharmaceuticals.</title><pubDate>Mon, 04 Nov 2019 02:27:29 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191572</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191572</guid><description><![CDATA[<p>authors: Poisal, John A</p><p>issue_mesh: Antipsychotic Agents/therapeutic use : Cardiovascular Agents/therapeutic use : Diuretics/therapeutic use : Drug Utilization/classification/statistics &#x26; numerical data : Fee-for-Service Plans : Female : Gastrointestinal Agents/therapeutic use : Health Benefit Plans, Employee : Health Maintenance Organizations : Health Services Research : Human : Male : Medicaid : Medicare/statistics &#x26; numerical data : United States</p><p>issue_number: 3</p><p>ntis_number: PB2000-102916</p><p>page_range: 119-123</p><p>primary_author: Waldron, Charles J</p><p>title: Five most commonly used types of pharmaceuticals.</p><p>volume: 20</p><p>year_period: 1999 Spring</p>]]></description></item><item><title>Determinants of enrollment among applicants to PACE.</title><pubDate>Mon, 04 Nov 2019 02:27:29 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191526</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191526</guid><description><![CDATA[<p>abstract: During the 1970s and 1980s, a new approach to the integration of acute and long-term care (LTC) services was conceived and refined at On Lok, an organization in the Chinese community of San Francisco. Since then, On Lok and 10 Federal demonstration sites have tested this model which is today called the Program of All-Inclusive Care for the Elderly (PACE). This program has gained considerable political support and as a result, the 1997 Balanced Budget Agreement establishes PACE as a permanent provider under Medicare. The Federal demonstration of PACE was designed as a voluntary program. By exploiting its voluntary enrollment design, this study analyzes the determinants of program participation within a group of screened applicants. Findings of this study support the theory that the capitated payment structure of PACE creates incentives for program staff to avoid costly individuals. However, home ownership and provider attachment also act as important and significant barriers to enrollment.</p><p>authors: Dorsey, Turahn; Massey, Susan</p><p>issue_mesh: Aged : Aged, 80 and over : Comprehensive Health Care/organization &#x26; administration/utilization : Data Collection : Decision Making : Demography : Female : Health Services for the Aged/organization &#x26; administration/utilization : Human : Insurance, Health, Reimbursement : Male : Medicare/organization &#x26; administration : Models, Organizational : Patient Acceptance of Health Care/statistics &#x26; numerical data : Program Evaluation : Support, U.S. Gov't, Non-P.H.S. : United States</p><p>issue_number: 2</p><p>ntis_number: PB99-109639</p><p>page_range: 135-153</p><p>primary_author: Irvin, Carol V</p><p>title: Determinants of enrollment among applicants to PACE.</p><p>volume: 19</p><p>year_period: 1997 Winter</p>]]></description></item><item><title>Future directions for the national health accounts</title><pubDate>Mon, 04 Nov 2019 02:27:29 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191614</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191614</guid><description><![CDATA[<p>page_range: 5-13</p><p>primary_author: Huskamp, Haiden A</p><p>title: Future directions for the national health accounts</p><p>volume: 21</p><p>year_period: 1999 Winter</p>]]></description></item><item><title>Hospital, employment, and price indicators for the health care industry: second quarter 1997.</title><pubDate>Mon, 04 Nov 2019 02:27:29 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191528</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191528</guid><description><![CDATA[<p>abstract: This regular feature of the journal includes a discussion of each of the following four topics: community hospital statistics; employment, hours, and earnings in the private health sector; health care prices; and national economic indicators. These statistics are valuable in their own right for understanding the relationship between the health care sector and the overall economy. In addition, they allow us to anticipate the direction and magnitude of health care cost changes prior to the availability of more comprehensive data.</p><p>authors: Donham, Carolyn S; Heffler, Stephen K</p><p>issue_mesh: Comparative Study : Data Collection : Employment/statistics &#x26; numerical data : Health Care Sector/statistics &#x26; numerical data/trends : Health Expenditures/statistics &#x26; numerical data : Hospitals, Community/statistics &#x26; numerical data : Medicare/economics : Salaries and Fringe Benefits/statistics &#x26; numerical data/trends : United States</p><p>issue_number: 2</p><p>ntis_number: PB99-109639</p><p>page_range: 159-201</p><p>primary_author: Sensenig, Arthur L</p><p>title: Hospital, employment, and price indicators for the health care industry: second quarter 1997.</p><p>volume: 19</p><p>year_period: 1997 Winter</p>]]></description></item><item><title>Hospital, employment, and price indicators for the health care industry: first quarter 1997.</title><pubDate>Mon, 04 Nov 2019 02:27:29 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191518</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191518</guid><description><![CDATA[<p>abstract: This regular feature of the journal includes a discussion of each of the following four topics: community hospital statistics; employment, hours, and earnings in the private health sector; health care prices; and national economic indicators. These statistics are valuable in their own right for understanding the relationship between the health care sector and the overall economy. In addition, they allow us to anticipate the direction and magnitude of health care cost changes prior to the availability of more comprehensive data.</p><p>authors: Donham, Carolyn S; Heffler, Stephen K</p><p>issue_mesh: Adult : Employment/statistics &#x26; numerical data : Health Care Costs/statistics &#x26; numerical data/trends : Health Care Sector/statistics &#x26; numerical data : Health Expenditures/statistics &#x26; numerical data/trends : Health Resources/utilization : Hospitals, Community/economics : Human : Medicare/economics : United States</p><p>issue_number: 1</p><p>ntis_number: PB99-109621</p><p>page_range: 207-249</p><p>primary_author: Sensenig, Arthur L</p><p>title: Hospital, employment, and price indicators for the health care industry: first quarter 1997.</p><p>volume: 19</p><p>year_period: 1997 Fall</p>]]></description></item><item><title>Overview: Changing health care systems: Trends in spending, coverage, and delivery</title><pubDate>Mon, 04 Nov 2019 02:27:29 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191548</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191548</guid><description><![CDATA[<p>issue_number: 1</p><p>ntis_number: PB2000-102914</p><p>page_range: 1-3</p><p>primary_author: Boben, Paul J</p><p>title: Overview: Changing health care systems: Trends in spending, coverage, and delivery</p><p>volume: 20</p><p>year_period: 1998 Fall</p>]]></description></item><item><title>Behavioral risk factor surveillance of aged Medicare beneficiaries, 1995.</title><pubDate>Mon, 04 Nov 2019 02:27:29 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191503</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191503</guid><description><![CDATA[<p>abstract: The Behavioral Risk Factor Surveillance System (BRFSS) is an ongoing State-based telephone survey of adults, administered through State health departments. The survey estimates health status and the prevalence of various risk factors among respondents, who include both fee-for-service and managed care Medicare beneficiaries. In this article the authors present an overview of the BRFSS and report 1995 regional results among respondents who were 65 years of age or over and who had health insurance. The advantages and disadvantages of using the BRFSS as a tool to monitor beneficiary health status and risk factors are also discussed.</p><p>authors: Arday, Susan L; Bolen, Julie; Chin, Joseph; Minor, Patrick; Rhodes, Luann</p><p>issue_mesh: Health Behavior : Health Status Indicators : Aged : Chronic Disease : Fee-for-Service Plans : Human : Managed Care Programs/utilization : Medicare/utilization : Patient Compliance : Preventive Health Services/utilization : Risk Factors : State Health Plans/utilization : Telephone : United States</p><p>issue_number: 4</p><p>ntis_number: PB99-109613</p><p>page_range: 105-123</p><p>primary_author: Arday, David R</p><p>title: Behavioral risk factor surveillance of aged Medicare beneficiaries, 1995.</p><p>volume: 18</p><p>year_period: 1997 Summer</p>]]></description></item><item><title>Blue Shield plan physician participation.</title><pubDate>Mon, 04 Nov 2019 02:27:29 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191601</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191601</guid><description><![CDATA[<p>abstract: Many Blue Shield Plans offer participation agreements to physicians that are structurally similar to the participation provisions of Medicaid programs. This paper examines physicians' participation decisions in two such Blue Shield Plans where the participation agreements were on an all-or-nothing basis. The major results show that increases in the Plans' reasonable fees or fee schedules significantly raise the probability of participation, and that physicians with characteristics associated with "low quality" are significantly more likely to participate than are physicians with characteristics associated with "high quality." In this sense the results highlight the tradeoff that must be faced in administering governmental health insurance policy. On the one hand, restricting reasonable and scheduled fees is the principal current tool for containing expenditures on physicians' services. Yet these restrictions tend to depress physicians' willingness to participate in government programs, thereby reducing access to high quality care by the populations those programs were designed to serve.</p><p>authors: Der, William; Ernst, Richard L; Hay, Joel W</p><p>issue_mesh: Physicians : Blue Shield/economics : Fee Schedules : Human : Insurance, Physician Services/economics : Models, Theoretical : Statistics : Support, U.S. Gov't, P.H.S. : United States</p><p>issue_number: 4</p><p>ntis_number: PB82-130154</p><p>page_range: 9-24</p><p>primary_author: Yett, Donald E</p><p>title: Blue Shield plan physician participation.</p><p>volume: 2</p><p>year_period: 1981 Spring</p>]]></description></item><item><title>Beneficiary centered care in services to persons with developmental disabilities.</title><pubDate>Mon, 04 Nov 2019 02:27:29 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191521</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191521</guid><description><![CDATA[<p>abstract: This article provides an overview of the findings from the Evaluation of Medicaid's Community Supported Living Arrangements (CSLA) Program. Results suggest that CSLA provided a useful model of beneficiary centered care for persons with developmental disabilities. The implications of the findings of this evaluation for current management of Medicaid programs are discussed.</p><p>authors: Burwell, Brian O; Lakin, K Charles</p><p>issue_mesh: Developmental Disabilities : Community Health Services/economics/organization &#x26; administration : Consumer Advocacy : Eligibility Determination : Facility Regulation and Control : Female : Group Homes/economics/organization &#x26; administration : Health Personnel/education : Health Services Research : Human : Inservice Training/organization &#x26; administration : Male : Medicaid/organization &#x26; administration : Models, Organizational : Patient-Centered Care/organization &#x26; administration : Program Evaluation : Risk Factors : Social Isolation : United States</p><p>issue_number: 2</p><p>ntis_number: PB99-109639</p><p>page_range: 23-46</p><p>primary_author: Brown, Samuel L</p><p>title: Beneficiary centered care in services to persons with developmental disabilities.</p><p>volume: 19</p><p>year_period: 1997 Winter</p>]]></description></item><item><title>Urban health care in transition: challenges facing Los Angeles County.</title><pubDate>Mon, 04 Nov 2019 02:27:29 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191551</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191551</guid><description><![CDATA[<p>abstract: The authors examine the Medicaid Section 1115 Demonstration Project currently underway in Los Angeles County. The waiver was designed as part of a response to a financial crisis the Los Angeles County Department of Health Services (LACDHS) faced in 1995. It provides financial relief to give the county time to restructure its system for serving the medically indigent population. Los Angeles County's goal is to reduce its traditional emphasis on emergency room and hospital care by building an integrated system of community-based primary, specialty, and public health care. This case study describes activities completed through the spring of 1997, approximately 1 year after the waiver was approved.</p><p>authors: Zuckerman, Stephen</p><p>issue_mesh: Community Health Services/economics/organization &#x26; administration : Delivery of Health Care, Integrated/organization &#x26; administration : Emergency Service, Hospital/utilization : Health Services Accessibility : Health Services Misuse : Hospitals, County/economics/organization &#x26; administration : Los Angeles : Medicaid/organization &#x26; administration : Organizational Case Studies : Public Health Administration : Support, U.S. Gov't, Non-P.H.S. : United States : Urban Health Services/economics/organization &#x26; administration</p><p>issue_number: 1</p><p>ntis_number: PB2000-102914</p><p>page_range: 45-58</p><p>primary_author: Long, Sharon K</p><p>title: Urban health care in transition: challenges facing Los Angeles County.</p><p>volume: 20</p><p>year_period: 1998 Fall</p>]]></description></item><item><title>Developing Medicare competitive bidding: a study of clinical laboratories.</title><pubDate>Mon, 04 Nov 2019 02:27:29 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191511</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191511</guid><description><![CDATA[<p>abstract: Competitive bidding to derive Medicare fees promises several advantages over administered fee systems. The authors show how incentives for cost savings, quality, and access can be incorporated into bidding schemes, and they report on a study of the clinical laboratory industry conducted in preparation for a bidding demonstration. The laboratory industry is marked by variable concentration across geographic markets and, among firms themselves, by social and economic heterogeneity. The authors conclude that these conditions can be accommodated by available bidding design options and by careful selection of bidding markets.</p><p>authors: Meadow, Ann</p><p>issue_mesh: Aged : Competitive Bidding/statistics &#x26; numerical data : Economic Competition : Health Care Sector : Health Services Research : Human : Laboratories/economics/statistics &#x26; numerical data : Laboratory Techniques and Procedures/economics : Medicare/economics/statistics &#x26; numerical data : United States</p><p>issue_number: 1</p><p>ntis_number: PB99-109621</p><p>page_range: 59-86</p><p>primary_author: Hoerger, Thomas J</p><p>title: Developing Medicare competitive bidding: a study of clinical laboratories.</p><p>volume: 19</p><p>year_period: 1997 Fall</p>]]></description></item><item><title>Medicaid managed care policies affecting children with disabilities: 1995 and 1996.</title><pubDate>Mon, 04 Nov 2019 02:27:29 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191498</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191498</guid><description><![CDATA[<p>abstract: The authors present findings from a study of State Medicaid managed care enrollment and benefit policies in 1995 and 1996 for children with disabilities. During this time the number of States serving children through fully capitated plans grew by more than one-third, and enrollment of children receiving Supplemental Security Income (SSI) payments and children in subsidized foster care increased. Most States required plans to provide all mandatory and most optional Medicaid services. Although States have begun to make noticeable improvements in their contract language concerning medical necessity and the early and periodic screening, diagnosis, and treatment (EPSDT) benefit, overall State guidance in these areas remains weak.</p><p>authors: Almeida, Ruth A; Lesser, Cara; McManus, Margaret A</p><p>issue_mesh: Disabled Children : Health Policy : Capitation Fee : Child : Eligibility Determination : Human : Managed Care Programs/economics/organization &#x26; administration : Medicaid/organization &#x26; administration : Social Security : State Health Plans/economics/organization &#x26; administration : Support, U.S. Gov't, P.H.S. : United States</p><p>issue_number: 4</p><p>ntis_number: PB99-109613</p><p>page_range: 23-36</p><p>primary_author: Fox, Harriette B</p><p>title: Medicaid managed care policies affecting children with disabilities: 1995 and 1996.</p><p>volume: 18</p><p>year_period: 1997 Summer</p>]]></description></item><item><title>An analysis of the effects of prospective reimbursement programs on hospital expenditures.</title><pubDate>Mon, 04 Nov 2019 02:27:29 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191595</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191595</guid><description><![CDATA[<p>abstract: Prospective reimbursement (PR) programs attempt to restrain increases in hospital expenditures by establishing, in advance of a hospital's fiscal year, limits on the reimbursement the hospital will receive for the services it provides to patients. We used data complied from a sample of approximately 2700 community hospitals in the U.S. for each year from 1969 to 1978 to estimate the effects of prospective reimbursement programs on hospital expenditures per patient day, per admission, and, to a lesser extent, per capita. The statistical evidence indicates that some PR programs have been successful in reducing hospital expenditures per patient day, per admission, and per capita. Eight programs--in Arizona, Connecticut, Maryland, Massachusetts, Minnesota, New Jersey, New York, and Rhode Island--have reduced the rate of increase in expenses by 2 percentage points or more per year and, in some cases, by as much as 4 to 6 percentage points. There are indications, although less strong, that PR programs also reduced expenses in Indiana, Kentucky, Washington, western Pennsylvania, and Wisconsin. There are no indications of cost reductions for programs in Colorado and Nebraska. An analysis of the relative effectiveness of the various programs suggests that mandatory programs have a significantly higher probability of influencing hospital behavior than do voluntary programs. Some voluntary programs, however, are shown to be effective.</p><p>authors: Sullivan, Daniel</p><p>issue_mesh: Cost Control : Prospective Payment System : Rate Setting and Review : Reimbursement Mechanisms : Analysis of Variance : Hospitals, Community/economics : Models, Theoretical : Regression Analysis : Support, U.S. Gov't, P.H.S. : United States</p><p>issue_number: 3</p><p>ntis_number: HRP0903015</p><p>page_range: 1-40</p><p>primary_author: Coelen, Craig</p><p>title: An analysis of the effects of prospective reimbursement programs on hospital expenditures.</p><p>volume: 2</p><p>year_period: 1981 Winter</p>]]></description></item><item><title>Trends and issues in the Medicaid 1915(c) waiver program</title><pubDate>Mon, 04 Nov 2019 02:27:29 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191581</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191581</guid><description><![CDATA[<p>abstract: Over the past 15 years, Medicaid 1915(c) home and community-based waivers have made a substantial contribution to States' efforts to transform their long-term care (LTC) systems from largely institutional to community-based systems. By 1997, every State had implemented a waiver program for at least some subgroups of individuals with disabilities, and expenditures increased from $3.8 million in 1982 to more than $8.1 billion in 1997. Emerging, as well as long-standing, policy issues related to the waiver program include concerns with access, variation in availability by disability group, State decisions related to the provision of community-based LTC, and evidence on effectiveness.</p><p>authors: Harrington, Charlene; Ramsland, Sarah</p><p>issue_mesh: Health Expenditures : Health Services Accessibility : Community Health Services/utilization : Disabled Persons : Institutional Practice : Long-Term Care : Medicaid/statistics &#x26; numerical data : United States</p><p>issue_number: 4</p><p>ntis_number: PB2000-102444</p><p>page_range: 139-160</p><p>primary_author: Miller, Nancy A</p><p>title: Trends and issues in the Medicaid 1915(c) waiver program</p><p>volume: 20</p><p>year_period: 1999 Summer</p>]]></description></item><item><title>Cost and financing of care for persons with HIV disease: an overview.</title><pubDate>Mon, 04 Nov 2019 02:27:29 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191531</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191531</guid><description><![CDATA[<p>abstract: This article explores the impact of new combination drug therapies on the cost and financing of human immunodeficiency virus (HIV) disease. Evidence indicates that the proportion of costs attributable to drugs has increased significantly since the diffusion of new combination drug therapies, and that the proportion of costs attributable to hospital inpatient care has decreased. The absence of timely data is the major difficulty in analyzing the impact of recent changes. Only two studies have examined costs since the diffusion of new combination drug therapies, and there are no recent studies of the insurance status of persons with HIV disease.</p><p>authors: N/A</p><p>issue_mesh: Cost of Illness : Anti-HIV Agents/administration &#x26; dosage/economics/therapeutic use : Drug Costs/statistics &#x26; numerical data : Drug Therapy, Combination : Female : Health Care Costs/statistics &#x26; numerical data : Health Services Research : HIV Infections/drug therapy/economics : HIV Protease Inhibitors/administration &#x26; dosage/economics/therapeutic use : Human : Male : Medicaid/statistics &#x26; numerical data/utilization : Racial Stocks : Sex Factors : Substance-Related Disorders : United States</p><p>issue_number: 3</p><p>ntis_number: PB2000-102912</p><p>page_range: 5-18</p><p>primary_author: Hellinger, Fred J</p><p>title: Cost and financing of care for persons with HIV disease: an overview.</p><p>volume: 19</p><p>year_period: 1998 Spring</p>]]></description></item><item><title>Medicaid mills: fact or fiction.</title><pubDate>Mon, 04 Nov 2019 02:27:29 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191586</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191586</guid><description><![CDATA[<p>abstract: Physician nonparticipation in Medicaid programs not only will restrict access of the poor to mainstream medicine but will also encourage the development of large Medicaid practices (LMPs). Policymakers have become increasingly concerned that these settings may be "Medicaid mills" in which low quality care is provided. Using HCFA survey data, this study examined the characteristics of LMPs, defined as practices in which at least 30 percent of the patients are eligible for Medicaid. Nearly 60 percent of all Medicaid patients treated in private practices are seen in these LMPs (14.5 percent of all practices). Most LMPs do not appear to be Medicaid mills. LMP physicians earn what other physicians make at best; often they earn less. Nor is there any widespread abuse of ancillary services, skimping on auxilliary staff, or excessive markups over costs, all characteristic of Medicaid mills. Visit lengths are shorter in LMPs, but only by a minute or two. A substantial "credentials gap" does exist, however; the Medicaid market is dominated by less qualified physicians. LMP physicians tend to be older, non-board certified, and graduates of foreign medical schools.</p><p>authors: Cromwell, Jerry L</p><p>issue_mesh: Clinical Competence : Comparative Study : Health Services Accessibility/economics : Income : Medicaid/economics : Practice Management, Medical/economics : Quality of Health Care/economics : United States</p><p>issue_number: 1</p><p>ntis_number: PB81-112823</p><p>page_range: 37-49</p><p>primary_author: Mitchell, Janet B</p><p>title: Medicaid mills: fact or fiction.</p><p>volume: 2</p><p>year_period: 1980 Summer</p>]]></description></item><item><title>Matching MCBS (Medicare Current Beneficiary Survey) and Medicare data: the best of both worlds.</title><pubDate>Mon, 04 Nov 2019 02:27:29 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191493</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191493</guid><description><![CDATA[<p>abstract: Survey reports from the Medicare Current Beneficiary Survey (MCBS) were matched to Medicare administrative files to create the 1992 MCBS Cost and Use file. This file improves on previous MCBS Access-to-Care user files by representing the entire (ever enrolled) Medicare population and including services not covered by Medicare such as outpatient prescription drugs and long-term facility care. The matching and reconciliation process improved the accuracy and completeness of health care use and cost. For example, Medicare billing data corrected 22 percent of survey reports that did not record Medicare as a payer and 39 percent in which the amount was missing.</p><p>authors: Chulis, George S</p><p>issue_mesh: Comparative Study : Health Care Costs/statistics &#x26; numerical data : Health Care Surveys/methods : Health Maintenance Organizations/economics/statistics &#x26; numerical data : Insurance Claim Review : Medicare/economics/statistics &#x26; numerical data/utilization : Nursing Homes/statistics &#x26; numerical data/utilization : Prescriptions, Drug/statistics &#x26; numerical data : United States : Utilization Review/statistics &#x26; numerical data</p><p>issue_number: 3</p><p>ntis_number: PB98-110554</p><p>page_range: 211-229</p><p>primary_author: Eppig, Franklin J</p><p>title: Matching MCBS (Medicare Current Beneficiary Survey) and Medicare data: the best of both worlds.</p><p>volume: 18</p><p>year_period: 1997 Spring</p>]]></description></item><item><title>Future research and policy directions in physician reimbursement.</title><pubDate>Mon, 04 Nov 2019 02:27:29 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191604</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191604</guid><description><![CDATA[<p>abstract: Payments to physicians absorb the second largest share of the health care dollar in the United States. In 1979, the share was 19 percent of the total, or $40.6 billion (Gibson, 1980). The Health Care Financing Administration (HCFA) alone spent $8.6 billion for physician services, representing approximately 16 percent of all public funds disbursed under HCFA programs. This paper presents an overview of various issues concerning physician reimbursement. Several major areas have been identified (access, cost, quality, and improving or refining the Office of Research, Demonstrations, and Statistics' [ORDS] research techniques for analyzing topics concerning physician reimbursement). Each area is introduced with a brief discussion of some of the problems associated with the physician reimbursement systems relating to that area. Selected results are then presented from the previous research in each area, along with descriptions of continuing studies currently underway. Each section concludes with a discussion of potential future directions for new research or data development.</p><p>authors: N/A</p><p>issue_mesh: Health Services Research/trends : Insurance, Physician Services/economics : Reimbursement Mechanisms : United States</p><p>issue_number: 4</p><p>ntis_number: PB82-130154</p><p>page_range: 61-75</p><p>primary_author: McMenamin, Peter</p><p>title: Future research and policy directions in physician reimbursement.</p><p>volume: 2</p><p>year_period: 1981 Spring</p>]]></description></item><item><title>Solutions for adverse selection in behavioral health care.</title><pubDate>Mon, 04 Nov 2019 02:27:29 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191487</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191487</guid><description><![CDATA[<p>abstract: Health plans have incentives to discourage high-cost enrollees (such as persons with mental illness) from joining. Public policy to counter incentives created by adverse selection is difficult when managed care controls cost through methods that are largely beyond the grasp of direct regulation. In this article, the authors evaluate three approaches to dealing with selection incentives: risk adjustment, the carving out of benefits, and cost- or risk-sharing between the payer and the plan. Adverse selection is a serious problem in the context of managed care. Risk adjustment is not likely to help much, but carving out the benefit and cost-sharing are promising directions for policy.</p><p>authors: Bae, Jay P; McGuire, Thomas G; Rupp, Agnes</p><p>issue_mesh: Insurance Selection Bias : Insurance, Psychiatric : Economic Competition : Health Policy : Human : Managed Care Programs/economics/utilization : Mental Disorders : Mental Health Services/economics/utilization : Risk : Support, U.S. Gov't, P.H.S. : United States</p><p>issue_number: 3</p><p>ntis_number: PB98-110554</p><p>page_range: 109-122</p><p>primary_author: Frank, Richard G</p><p>title: Solutions for adverse selection in behavioral health care.</p><p>volume: 18</p><p>year_period: 1997 Spring</p>]]></description></item><item><title>Health care in China after Mao.</title><pubDate>Mon, 04 Nov 2019 02:27:27 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191596</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191596</guid><description><![CDATA[<p>abstract: This article summarizes observations made by the author during a recent trip to China and compares these views to those of other observers over the past decade. The discussion is undoubtedly influenced by the Chinese tendency to speak in terms of the ideal rather than what exists. It was often difficult to sort out "what is" from "what ought to be," even though our hosts appeared very candid, and, for the most part, our observations confirmed what we were told. Interpretation of observations is also colored by China's new surge of leadership, which causes health care policies to be in a continual state of transition. This makes any paper on contemporary Chinese health care somewhat outdated by the time it is published. However, there appear to be larger concerns reflecting basic Chinese attitudes toward health care that have evolved during the post "Liberation" period and which underlie day-to-day policy fluctuations. The analysis which follows attempts to isolate basic trends from more transitory events to clarify the the essential aspects of Chinese health care policy.</p><p>authors: N/A</p><p>issue_mesh: Health Policy : National Health Programs : State Medicine : China</p><p>issue_number: 3</p><p>ntis_number: HRP0903015</p><p>page_range: 41-53</p><p>primary_author: Dobson, Allen</p><p>title: Health care in China after Mao.</p><p>volume: 2</p><p>year_period: 1981 Winter</p>]]></description></item><item><title>National health expenditures, 1997.</title><pubDate>Mon, 04 Nov 2019 02:27:27 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191554</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191554</guid><description><![CDATA[<p>abstract: In 1997 health spending in the United States increased just 4.8 percent to $1.1 trillion. As a share of gross domestic product (GDP), national health expenditures (NHE) absorbed 13.5 percent of the country's output in 1997--a share that has remained relatively constant for 5 years. Despite the relative stability in recent years, signs of changing trends are emerging.</p><p>authors: Cowan, Cathy A; Donham, Carolyn S; Lazenby, Helen C; Long, Anna M; Martin, Anne B; McDonnell, Patricia A; Sensenig, Arthur L; Stewart, Madie W; Stiller, Jean M; Whittle, Lekha S</p><p>issue_mesh: Advertising/economics/statistics &#x26; numerical data : Bed Occupancy/statistics &#x26; numerical data : Data Collection : Drug Costs/statistics &#x26; numerical data/trends : Eligibility Determination : Financing, Personal/trends : Health Expenditures/statistics &#x26; numerical data/trends : Home Care Services/economics : Hospital Costs/statistics &#x26; numerical data : Insurance, Pharmaceutical Services/statistics &#x26; numerical data : Managed Care Programs/economics/statistics &#x26; numerical data : Medicaid/economics/statistics &#x26; numerical data : Medicare/economics/statistics &#x26; numerical data : Private Sector : United States</p><p>issue_number: 1</p><p>ntis_number: PB2000-102914</p><p>page_range: 83-126</p><p>primary_author: Braden, Bradley R</p><p>title: National health expenditures, 1997.</p><p>volume: 20</p><p>year_period: 1998 Fall</p>]]></description></item><item><title>Barriers to physician care for Medicare beneficiaries.</title><pubDate>Mon, 04 Nov 2019 02:27:27 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191536</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191536</guid><description><![CDATA[<p>authors: Poisal, John A</p><p>issue_mesh: Medicare Assignment : Aged : Data Collection : Fees, Medical : Health Services Accessibility/economics : Human : Patient Acceptance of Health Care/statistics &#x26; numerical data : Personal Health Services/economics/utilization : United States</p><p>issue_number: 3</p><p>ntis_number: PB2000-102912</p><p>page_range: 101-104</p><p>primary_author: Murray, Lauren A</p><p>title: Barriers to physician care for Medicare beneficiaries.</p><p>volume: 19</p><p>year_period: 1998 Spring</p>]]></description></item><item><title>Health insurance coverage at midlife: characteristics, costs, and dynamics.</title><pubDate>Mon, 04 Nov 2019 02:27:27 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191488</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191488</guid><description><![CDATA[<p>abstract: Recent data from the first two waves of the Health and Retirement Study are analyzed to evaluate prevalence of different types of health insurance, characteristics of different plan types, and changes in coverage as individuals approach retirement age. Although overall rates of coverage are quite high among the middle-aged, the risk of noncoverage is high within many disadvantaged groups, including Hispanics, low-wage earners, and the recently disabled. Sixty percent of individuals with health benefits are enrolled in health maintenance organizations (HMOs) or preferred provider organizations (PPOs). In addition, one-fourth of enrollees in fee-for-service (FFS) plans report restrictions in their access to specialists.</p><p>authors: Crystal, Stephen</p><p>issue_mesh: Age Factors : Costs and Cost Analysis : Demography : Female : Health Benefit Plans, Employee/statistics &#x26; numerical data : Health Care Surveys : Human : Insurance Coverage/statistics &#x26; numerical data : Insurance, Health/classification/statistics &#x26; numerical data : Logistic Models : Longitudinal Studies : Male : Middle Age : Support, Non-U.S. Gov't : Support, U.S. Gov't, P.H.S. : United States</p><p>issue_number: 3</p><p>ntis_number: PB98-110554</p><p>page_range: 123-148</p><p>primary_author: Johnson, Richard W</p><p>title: Health insurance coverage at midlife: characteristics, costs, and dynamics.</p><p>volume: 18</p><p>year_period: 1997 Spring</p>]]></description></item><item><title>Selection experiences in Medicare HMOs: Pre-enrollment expenditures</title><pubDate>Mon, 04 Nov 2019 02:27:27 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191584</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191584</guid><description><![CDATA[<p>abstract: Using 1993 and 1994 data, the authors examine whether beneficiaries who enroll in a Medicare health maintenance organization (HMO), including those enrolling for only a short period of time, have lower expenditures than continuous fee-for-service (FFS) beneficiaries the year prior to enrollment. We also test whether biased selection varies by the level of HMO market penetration and the rate of market-share growth. We find favorable selection associated with enrollment into Medicare HMOs, which declines as market share increases but does not disappear. Among short-term enrollees, we find unfavorable selection, however, selection bias was not sensitive to market characteristics.</p><p>authors: Dowd, Bryan; Feldman, Roger; Maciejewski, Matthew</p><p>issue_mesh: Health Expenditures : Insurance Selection Bias : Aged : Evaluation Studies : Fee-for-Service Plans : Health Maintenance Organizations : Medicare : Regression Analysis : Risk Factors : Support, U.S. Gov't, non-P.H.S. : United States</p><p>issue_number: 4</p><p>ntis_number: PB2000-102444</p><p>page_range: 197-209</p><p>primary_author: Call, Kathleen T</p><p>title: Selection experiences in Medicare HMOs: Pre-enrollment expenditures</p><p>volume: 20</p><p>year_period: 1999 Summer</p>]]></description></item><item><title>Risk adjustment for dually eligible beneficiaries using long-term care.</title><pubDate>Mon, 04 Nov 2019 02:27:27 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191561</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191561</guid><description><![CDATA[<p>abstract: This study explores use of the principal inpatient diagnostic cost groups (PIPDCG) and hierarchical coexisting conditions (HCC) risk-adjustment methodologies for a population of dually eligible beneficiaries receiving chronic long-term care (LTC). Measures of individual predictive accuracy for this population compared with the total Medicare population were similar for the PIPDCG models but somewhat smaller for the HCC models. Incorporating measures of functional status increased the R2 values by only a small amount for Medicare expenditures but by a somewhat larger amount for total expenditures. Addition of other variables, especially placement, further improved the predictive power.</p><p>authors: Korb, Jodi</p><p>issue_mesh: Medicaid : Medicare : Aged : Eligibility Determination/economics : Human : Long-Term Care/economics : Regression Analysis : Support, U.S. Gov't, Non-P.H.S. : United States</p><p>issue_number: 2</p><p>ntis_number: PB2000-102915</p><p>page_range: 71-90</p><p>primary_author: McCall, Nelda</p><p>title: Risk adjustment for dually eligible beneficiaries using long-term care.</p><p>volume: 20</p><p>year_period: 1998 Winter</p>]]></description></item><item><title>Dialysis modality selection among patients attending freestanding dialysis facilities.</title><pubDate>Mon, 04 Nov 2019 02:27:27 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191497</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191497</guid><description><![CDATA[<p>abstract: Persons with end stage renal disease (ESRD) are eligible to receive dialysis services under the Medicare program. An individual-level analysis was performed to determine the factors associated with the modality selected by patients; namely in-center hemodialysis, continuous ambulatory peritoneal dialysis (CAPD), continuous cycling peritoneal dialysis (CCPD), and home hemodialysis. Logistic regression equations were estimated using program data for 73,448 ESRD Medicare patients attending freestanding dialysis facilities. The results showed that CAPD, CCPD, and home hemodialysis were more likely to be selected by patients who were younger, had non-systemic precipitating causes of ESRD, had a shorter duration of ESRD, attended larger facilities, and were not ethnic minorities. There is no consistent evidence demonstrating the superiority of particular modalities. The policy goal should be to enable beneficiaries to use the modality for which they are best suited, which requires that the range of modalities be available to all ESRD beneficiaries.</p><p>authors: N/A</p><p>issue_mesh: Adult : Aged : Ambulatory Care Facilities/utilization : Choice Behavior : Demography : Female : Health Policy : Hemodialysis, Home/utilization : Hemodialysis/methods/utilization : Human : Kidney Failure, Chronic/therapy : Logistic Models : Male : Medicare : Middle Age : Patient Acceptance of Health Care/statistics &#x26; numerical data : Peritoneal Dialysis, Continuous Ambulatory/utilization : Regression Analysis : United States</p><p>issue_number: 4</p><p>ntis_number: PB99-109613</p><p>page_range: 3-21</p><p>primary_author: Kendix, Michael</p><p>title: Dialysis modality selection among patients attending freestanding dialysis facilities.</p><p>volume: 18</p><p>year_period: 1997 Summer</p>]]></description></item><item><title>Explosion in the medicine chest.</title><pubDate>Mon, 04 Nov 2019 02:27:27 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191564</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191564</guid><description><![CDATA[<p>abstract: This overview ties together the various articles by relating them to the current debate on whether, and how, the Medicare program can add outpatient drugs as a covered benefit. The unifying theme for most of the articles is that they outline possible ways of administering a drug benefit and discuss policy issues that will arise, based on Health Care Financing Administration (HCFA) experiences or State government experiences in efforts to administer existing drug benefits in a cost-effective manner while attempting to ensure the best medical outcomes. The articles provide information about drug utilization among Medicare beneficiaries with and without insurance coverage, among Medicaid beneficiaries, and among subpopulations for whom drug therapies can be considered essential.</p><p>authors: N/A</p><p>issue_mesh: Aged : Ambulatory Care/economics : Cost-Benefit Analysis : Drug Utilization Review : Health Care Financing Administration : Human : Insurance, Pharmaceutical Services/economics/legislation &#x26; jurisprudence : Medicaid/economics/legislation &#x26; jurisprudence : Medicare/economics/legislation &#x26; jurisprudence : United States</p><p>issue_number: 3</p><p>ntis_number: PB2000-102916</p><p>page_range: 1-13</p><p>primary_author: Zarabozo, Carlos</p><p>title: Explosion in the medicine chest.</p><p>volume: 20</p><p>year_period: 1999 Spring</p>]]></description></item><item><title>Overview: Measuring and improving the health status of the elderly, poor, and disabled</title><pubDate>Mon, 04 Nov 2019 02:27:27 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191496</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191496</guid><description><![CDATA[<p>issue_number: 4</p><p>ntis_number: PB99-109613</p><p>page_range: 1-2</p><p>primary_author: Kendix, Michael</p><p>title: Overview: Measuring and improving the health status of the elderly, poor, and disabled</p><p>volume: 18</p><p>year_period: 1997 Summer</p>]]></description></item><item><title>Strategies for containing drug costs: implications for a Medicare benefit.</title><pubDate>Mon, 04 Nov 2019 02:27:27 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191566</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191566</guid><description><![CDATA[<p>abstract: As policymakers consider adding a prescription drug benefit to Medicare, cost containment will be an important issue. This article discusses strategies to hold down the prices paid for prescription drugs. Within the private sector these include the use of formularies, the emergence of pharmaceutical benefit management companies, and the expansion of mail order pharmacies. In the Federal Government, costs are contained by the Medicaid drug rebate and the Federal Supply Schedule (FSS) of prices. Since Medicare beneficiaries constitute a large share of the prescription drug market, getting access to FSS prices may not be feasible. A flat rebate is one alternative.</p><p>authors: N/A</p><p>issue_mesh: Drug Costs : Insurance, Pharmaceutical Services : Aged : Cost Control/methods : Fee Schedules : Human : Medicaid/economics : Medicare/economics : Policy Making : Private Sector : United States</p><p>issue_number: 3</p><p>ntis_number: PB2000-102916</p><p>page_range: 29-37</p><p>primary_author: Cook, Anna E</p><p>title: Strategies for containing drug costs: implications for a Medicare benefit.</p><p>volume: 20</p><p>year_period: 1999 Spring</p>]]></description></item><item><title>S/HMO versus TEFRA HMO enrollees: Analysis of expenditures</title><pubDate>Mon, 04 Nov 2019 02:27:27 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191574</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191574</guid><description><![CDATA[<p>abstract: This study compares expenditures on health care services for enrollees in a social health maintenance organization (S/HMO) and a Tax Equity and Fiscal Responsibility Act of 1982 (TEFRA)-risk Medicare health maintenance organization (HMO). In addition to the traditional Medicare services covered by the TEFRA HMO, the S/HMO provided a long-term care (LTC) benefit and case management services for chronic illness. There do not appear to be any overall savings associated with S/HMO membership, including any savings from substitution of S/HMO-specific services for other, traditional services covered by both the S/HMO and the TEFRA HMO.</p><p>authors: Fischer, Lucy R; Hillson, Steve; VonSternberg, Tom</p><p>issue_mesh: Health Expenditures : Health Maintenance Organizations : Program Evaluation : Tax Equity and Fiscal Responsibility Act : Aged : Chronic Disease : Data Collection : Evaluation Studies : Long-Term Care/economics : Medicare : Multivariate Analysis : Questionnaire : Support, U.S. Gov't, P.H.S. : United States</p><p>issue_number: 4</p><p>ntis_number: PB2000-102444</p><p>page_range: 7-23</p><p>primary_author: Dowd, Bryan</p><p>title: S/HMO versus TEFRA HMO enrollees: Analysis of expenditures</p><p>volume: 20</p><p>year_period: 1999 Summer</p>]]></description></item><item><title>Effects of supplemental coverage on use of services by Medicare enrollees [corrected and republished in Health Care Finance Rev 1997 Winter;19(2):suppl 5-17 following 218]</title><pubDate>Mon, 04 Nov 2019 02:27:27 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191508</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191508</guid><description><![CDATA[<p>abstract: This article estimates the extent to which private insurance supplements affect use of services by Medicare enrollees. Three types of supplements to Medicare's coverage are examined--Health Maintenance Organizations (HMOs), medigap (MGP) plans, and employment-based indemnity (EBI) plans. While each kind of supplement reduces cost sharing on Medicare-covered services, only HMOs do so without increasing enrollees' overall use of services. Use of services by HMO enrollees is about 4 percent lower than use by similar Medicare enrollees with no insurance supplement. By contrast, use of services by enrollees with MGP coverage is 28 percent higher, and use of services by enrollees with EBI plans is 17 percent higher.</p><p>authors: Shinogle, Judy</p><p>issue_mesh: Insurance Coverage : Adolescence : Adult : Aged : Comparative Study : Female : Health Benefit Plans, Employee/statistics &#x26; numerical data/utilization : Health Care Surveys : Health Maintenance Organizations/utilization : Health Services Needs and Demand/statistics &#x26; numerical data : Human : Insurance, Medigap/utilization : Male : Medicare/statistics &#x26; numerical data/utilization : United States</p><p>issue_number: 1</p><p>ntis_number: PB99-109621</p><p>page_range: 5-17</p><p>primary_author: Christensen, Sandra</p><p>title: Effects of supplemental coverage on use of services by Medicare enrollees [corrected and republished in Health Care Finance Rev 1997 Winter;19(2):suppl 5-17 following 218]</p><p>volume: 19</p><p>year_period: 1997 Fall</p>]]></description></item><item><title>Medicaid TEFRA option in Minnesota: Implications for patient rights</title><pubDate>Mon, 04 Nov 2019 02:27:27 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191611</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191611</guid><description><![CDATA[<p>page_range: 65-78</p><p>primary_author: Chan, Benjamin</p><p>title: Medicaid TEFRA option in Minnesota: Implications for patient rights</p><p>volume: 21</p><p>year_period: 1999 Fall</p>]]></description></item><item><title>Hospitalizations for injury among Medicaid children: California, 1992.</title><pubDate>Mon, 04 Nov 2019 02:27:27 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191546</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191546</guid><description><![CDATA[<p>abstract: Little is known about the incidence and cost of injuries for Medicaid children. This article provides data on hospitalization utilization and payments for injuries among Medicaid children, using the Health Care Financing Administration's (HCFA) State Medicaid Research Files. During 1992, there were nearly 17,000 injury hospitalizations for California's Medicaid children (758 per 100,000 enrollees), representing over $93 million in program payments. The most frequent injury hospitalizations were fractures and dislocations. Disabled children and 18- to 20-year-old males experienced the highest hospital utilization rates. These findings will assist Medicaid policymakers in targeting prevention efforts to reduce incidence and program payments for children's injuries.</p><p>authors: Boschert, Richard; Hakim, Rosemarie B; Rotwein, Suzanne</p><p>issue_mesh: Child : Medicaid/economics/utilization : Disabled Persons : Health Care Financing Administration : Hospitalization/economics/statistics &#x26; numerical data/utilization : Human : State : United States</p><p>issue_number: 4</p><p>ntis_number: PB2000-102913</p><p>page_range: 129-147</p><p>primary_author: Baugh, David K</p><p>title: Hospitalizations for injury among Medicaid children: California, 1992.</p><p>volume: 19</p><p>year_period: 1998 Summer</p>]]></description></item><item><title>Evaluation results from prospective drug utilization review: Medicaid demonstrations.</title><pubDate>Mon, 04 Nov 2019 02:27:27 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191571</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191571</guid><description><![CDATA[<p>abstract: In 1992 HCFA awarded two cooperative agreements for demonstrations of prospective drug utilization review (PDUR). Iowa tested an on-line prospective drug utilization review (OPDUR) system. Washington tested payments to pharmacists for providing non-dispensing "cognitive services" (CS). In this article the authors report on an evaluation of these demonstrations and on three assessments of retrospective drug utilization review (RDUR) interventions. The evaluation failed to detect effects of either State PDUR demonstration on the frequency of drug problems, utilization of prescription drugs and other health services, and clinical outcomes. However, the State RDUR interventions had immediate effects on prescribing physicians.</p><p>authors: Bae, Jay P</p><p>issue_mesh: Costs and Cost Analysis : Data Collection : Drug Therapy/adverse effects : Drug Utilization Review/methods : Evaluation Studies : Health Care Financing Administration : Insurance, Health, Reimbursement/economics/statistics &#x26; numerical data : Iowa : Medicaid/organization &#x26; administration : Outcome Assessment (Health Care) : Pilot Projects : State Health Plans/organization &#x26; administration : United States : Washington</p><p>issue_number: 3</p><p>ntis_number: PB2000-102916</p><p>page_range: 107-118</p><p>primary_author: Kidder, David</p><p>title: Evaluation results from prospective drug utilization review: Medicaid demonstrations.</p><p>volume: 20</p><p>year_period: 1999 Spring</p>]]></description></item><item><title>Overview: Changing environments of AIDS/HIV service delivery and financing</title><pubDate>Mon, 04 Nov 2019 02:27:27 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191530</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191530</guid><description><![CDATA[<p>issue_number: 3</p><p>ntis_number: PB2000-102912</p><p>page_range: 1-3</p><p>primary_author: Pine, Penelope L</p><p>title: Overview: Changing environments of AIDS/HIV service delivery and financing</p><p>volume: 19</p><p>year_period: 1998 Spring</p>]]></description></item><item><title>Measuring and improving the health status of end stage renal disease patients.</title><pubDate>Mon, 04 Nov 2019 02:27:27 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191501</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191501</guid><description><![CDATA[<p>abstract: This highlight reports on recent efforts to develop and promote health status measurement instruments for use in dialysis units that treat end-stage renal disease (ESRD) patients, most of whom are covered for all medical services under Medicare. Readers interested in a more detailed discussion of instruments, including associated data collection and data processing aspects, should consult a recently published account, with its extensive references, of four instruments currently being used in dialysis units (Rettig et al., 1997). Those interested in early reports of the clinical utility of such instruments should consult the following references (Kurtin et al., 1992; Meyer et al., 1994; and DeOreo, 1997).</p><p>authors: Sadler, John H</p><p>issue_mesh: Health Status Indicators : Hemodialysis/psychology : Human : Institute of Medicine (U.S.) : Kidney Failure, Chronic/classification/psychology : Medicare : Outcome Assessment (Health Care) : Quality of Health Care/statistics &#x26; numerical data : Quality of Life : Self Assessment (Psychology) : United States</p><p>issue_number: 4</p><p>ntis_number: PB99-109613</p><p>page_range: 77-82</p><p>primary_author: Rettig, Richard A</p><p>title: Measuring and improving the health status of end stage renal disease patients.</p><p>volume: 18</p><p>year_period: 1997 Summer</p>]]></description></item><item><title>Medicaid home and community-based care waiver programs: providing services to people with AIDS.</title><pubDate>Mon, 04 Nov 2019 02:27:27 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191502</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191502</guid><description><![CDATA[<p>abstract: The authors present the results of a survey demonstrating how Medicaid programs use the home and community-based waiver programs to provide services to people with acquired immunodeficiency syndrome (AIDS) and to other targeted groups. The survey identified a number of waiver services that are effective at meeting the care needs of people with AIDS, such as case management, personal care, respite care, home intravenous therapy, attendant care, hospice, and home-delivered meals. The study demonstrates that in addition to the AIDS-specific waiver program, State Medicaid programs use the home and community-based care waiver programs for the elderly and disabled to provide services to people with AIDS because of their disability status.</p><p>authors: Chakravorty, Bonnie J</p><p>issue_mesh: Acquired Immunodeficiency Syndrome/economics/therapy : Case Management : Community Health Services/economics/organization &#x26; administration : Disabled Persons : Eligibility Determination : Health Care Surveys : Health Services Needs and Demand : Home Care Services/economics/organization &#x26; administration : Medicaid/organization &#x26; administration : Questionnaires : State Health Plans/organization &#x26; administration : Support, U.S. Gov't, P.H.S. : United States</p><p>issue_number: 4</p><p>ntis_number: PB99-109613</p><p>page_range: 83-103</p><p>primary_author: Buchanan, Robert J</p><p>title: Medicaid home and community-based care waiver programs: providing services to people with AIDS.</p><p>volume: 18</p><p>year_period: 1997 Summer</p>]]></description></item><item><title>Business, households, and government: health care spending, 1995.</title><pubDate>Mon, 04 Nov 2019 02:27:27 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191491</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191491</guid><description><![CDATA[<p>abstract: For the period 1990-95, we will present data on health care spending by business, households, and government. In addition, we will measure the relative impact of these expenditures on each sector's ability to pay. In 1994 and 1995, health care costs experienced the slowest growth in 3 decades. Combined with healthy revenue growth, slow cost growth helped ease or stabilize the financing burden faced by business, households and government.</p><p>authors: Braden, Bradley R</p><p>issue_mesh: Data Collection : Employer Health Costs/statistics &#x26; numerical data : Financing, Personal/statistics &#x26; numerical data : Health Care Costs/statistics &#x26; numerical data/trends : Health Expenditures/statistics &#x26; numerical data : Insurance, Health/statistics &#x26; numerical data : Medicare/statistics &#x26; numerical data/trends : Private Sector/economics : Salaries and Fringe Benefits/trends : United States</p><p>issue_number: 3</p><p>ntis_number: PB98-110554</p><p>page_range: 195-206</p><p>primary_author: Cowan, Cathy A</p><p>title: Business, households, and government: health care spending, 1995.</p><p>volume: 18</p><p>year_period: 1997 Spring</p>]]></description></item><item><title>Overview: Child and adolescent preventive care: Access, quality, and outcomes.</title><pubDate>Mon, 04 Nov 2019 02:27:27 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191538</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191538</guid><description><![CDATA[<p>abstract: This issue features child and adolescent health care, focusing especially on the effectiveness of the 1989 Omnibus Budget Reconciliation Act (OBRA 89), which expanded health benefits to more children and pregnant women in Medicaid. Also featured: the effectiveness of some managed health care plans for Medicaid-eligible children, and injury hospitalizations in California in 1992. Some of the material is particularly relevant to the Children's Health Insurance Program (CHIP), which is the current effort to insure the Nation's working poor.</p><p>authors: N/A</p><p>issue_mesh: Child : Medicaid : California : Evaluation Studies : United States</p><p>issue_number: 4</p><p>ntis_number: PB2000-102913</p><p>page_range: 1-3</p><p>primary_author: Hakim, Rosemarie B</p><p>title: Overview: Child and adolescent preventive care: Access, quality, and outcomes.</p><p>volume: 19</p><p>year_period: 1998 Summer</p>]]></description></item><item><title>Patterns of Medicaid eligibility: a sample of 408 Medi-Cal eligibles in San Francisco, California.</title><pubDate>Mon, 04 Nov 2019 02:27:26 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191600</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191600</guid><description><![CDATA[<p>abstract: Medicaid expenditures per recipient have increased substantially in the past decade, even after controlling for medical care price inflation. In response to this Medicaid expenditure growth, various policies to encourage Medicaid enrollment in cost-effective health maintenance organizations (HMOs) are being considered, including guaranteed Medicaid eligibility for Medicaid eligibles enrolled in HMOs. This paper addresses several important questions about Medicaid eligibility that are essential to an analysis of guaranteed eligibility--the length of eligibility, turnover rates, and reasons individuals lose their Medicaid eligibility. We selected a stratified random sample of 408 eligibility case files for individuals eligible for Medicaid in San Francisco County during December 1977. Six aid categories are represented in this study: (1) Cash Grant AFDC; (2) Medically Needy Families; (3) Medically Needy Aged; (4) Medically Needy Disabled; (5) Medically indigent Adults; and (6) Medically indigent Children. We found that the majority of individuals remain eligible for Medicaid for long, uninterrupted spells, ranging from a median of 15 months (Medically Indigent Adults) to 40 months (Medically Needy Aged). A much smaller subset of eligible persons had relatively short spells and higher turnover; some of that turnover was due to failure to comply with income reporting requirements. We used data on length of eligibility to estimate the cost impact of 6 months' guaranteed eligibility (for months during which individuals would otherwise not have been eligible for Medicaid benefits). We also estimated the potential benefits (savings of HMOs relative to average fee-for-service expenditures) and the benefits of guaranteed eligibility appear to be greater than the costs.</p><p>authors: Newacheck, Paul W; Showstack, Jonathon A</p><p>issue_mesh: Eligibility Determination : California : Medicaid/utilization</p><p>issue_number: 4</p><p>ntis_number: PB82-130154</p><p>page_range: 1-8</p><p>primary_author: Celum, Connie L</p><p>title: Patterns of Medicaid eligibility: a sample of 408 Medi-Cal eligibles in San Francisco, California.</p><p>volume: 2</p><p>year_period: 1981 Spring</p>]]></description></item><item><title>Inpatient psychiatric care of Medicare beneficiaries with state buy-in coverage.</title><pubDate>Mon, 04 Nov 2019 02:27:26 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191560</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191560</guid><description><![CDATA[<p>abstract: Administrative data were used to compare length of stay, Medicare payment, total and average daily costs, discharge destinations, rehospitalizations, and emergency room (ER) use of dually eligible and non-dually eligible Medicare inpatients admitted for a psychiatric diagnosis. Regressions controlled for State buy-in coverage as a proxy for dual eligibility, hospital type, and beneficiary sociodemographic and clinical characteristics. Measures of severity within diagnostic category were limited to comorbidities. Among disabled beneficiaries, dually eligible beneficiaries had lower costs and shorter stays. Among elderly and disabled persons, dually eligible beneficiaries had higher rates of rehospitalization, post-discharge ER use without admission, and discharge to destinations other than self-care.</p><p>authors: N/A</p><p>issue_mesh: Aged : Disabled Persons : Eligibility Determination/economics : Human : Length of Stay/economics : Medicaid/economics/statistics &#x26; numerical data/utilization : Medicare/economics/statistics &#x26; numerical data/utilization : Psychiatric Department, Hospital/utilization : Regression Analysis : Support, U.S. Gov't, Non-P.H.S. : United States</p><p>issue_number: 2</p><p>ntis_number: PB2000-102915</p><p>page_range: 55-69</p><p>primary_author: Ettner, Susan L</p><p>title: Inpatient psychiatric care of Medicare beneficiaries with state buy-in coverage.</p><p>volume: 20</p><p>year_period: 1998 Winter</p>]]></description></item><item><title>Hospital, employment, and price indicators for the health care industry: third quarter 1996.</title><pubDate>Mon, 04 Nov 2019 02:27:26 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191494</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191494</guid><description><![CDATA[<p>abstract: This regular feature of the journal includes a discussion of each of the following four topics: community hospital statistics; employment, hours, and earnings in the private health sector; health care prices; and national economic indicators. These statistics are valuable in their own right for understanding the relationship between the health care sector and the overall economy. In addition, they allow us to anticipate the direction and magnitude of health care cost changes prior to the availability of more comprehensive data.</p><p>authors: Donham, Carolyn S; Heffler, Stephen K</p><p>issue_mesh: Data Collection : Economics/trends : Employment/statistics &#x26; numerical data/trends : Fees, Medical/statistics &#x26; numerical data/trends : Hospitals, Community/economics/statistics &#x26; numerical data/utilization : Length of Stay/statistics &#x26; numerical data/trends : Medicare/economics/statistics &#x26; numerical data : Patient Admission/statistics &#x26; numerical data/trends : Private Sector/economics : Salaries and Fringe Benefits/statistics &#x26; numerical data/trends : United States</p><p>issue_number: 3</p><p>ntis_number: PB98-110554</p><p>page_range: 231-273</p><p>primary_author: Sensenig, Arthur L</p><p>title: Hospital, employment, and price indicators for the health care industry: third quarter 1996.</p><p>volume: 18</p><p>year_period: 1997 Spring</p>]]></description></item><item><title>Cost savings and physician responses to global bundled payments for Medicare heart bypass surgery.</title><pubDate>Mon, 04 Nov 2019 02:27:26 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191510</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191510</guid><description><![CDATA[<p>abstract: In 1991 the Health Care Financing Administration (HCFA) began the Medicare Participating Heart Bypass Center Demonstration, in which hospitals and physicians are paid a single negotiated global price for all inpatient care for heart bypass patients. During the first 27 months of the demonstration, the Government and beneficiaries together saved more than $17 million on bypass surgery in four participating institutions. Average total cost per case fell in three of the four hospitals during the 1990-93 period as the alignment of physician and hospital incentives resulted in physicians changing their practice patterns to shorten stays and reduce costs.</p><p>authors: Dayhoff, Debra A; Thoumaian, Armen H</p><p>issue_mesh: Aged : Coronary Artery Bypass/economics : Cost Savings/statistics &#x26; numerical data : Female : Health Services Research : Hospital Costs/trends : Human : Length of Stay : Male : Medicare/economics/statistics &#x26; numerical data : Physician's Practice Patterns/economics : Pilot Projects : Rate Setting and Review/methods : Support, U.S. Gov't, P.H.S. : United States</p><p>issue_number: 1</p><p>ntis_number: PB99-109621</p><p>page_range: 41-57</p><p>primary_author: Cromwell, Jerry L</p><p>title: Cost savings and physician responses to global bundled payments for Medicare heart bypass surgery.</p><p>volume: 19</p><p>year_period: 1997 Fall</p>]]></description></item><item><title>Capitated payment approaches for Medicaid-financed long-term care services</title><pubDate>Mon, 04 Nov 2019 02:27:26 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191610</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191610</guid><description><![CDATA[<p>page_range: 51-64</p><p>primary_author: Rudolph, Noemi V</p><p>title: Capitated payment approaches for Medicaid-financed long-term care services</p><p>volume: 21</p><p>year_period: 1999 Fall</p>]]></description></item><item><title>Use of home health care by ESRD and Medicare beneficiaries</title><pubDate>Mon, 04 Nov 2019 02:27:26 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191580</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191580</guid><description><![CDATA[<p>abstract: The use of home health care (HHC) services among Medicare end stage renal disease (ESRD) enrollees remains an under-studied area. In this article, the authors report sociodemographic characteristics and patterns of HHC utilization by Medicare-covered ESRD patients. The authors found that those who were female, age 85 or over, diabetic, and residing in the New England or West South Central census divisions were more likely to use HHC services and were also more intensive users. Analysis of use patterns in such high-risk populations is necessary to ensure that health policy changes do not have unintended consequences for vulnerable patients.</p><p>authors: Shih, Ya C</p><p>issue_mesh: Home Care Services/utilization : Aged : Aged, 80 and over : Comparative Study : Female : Male : Medicare : Regression Analysis : United States</p><p>issue_number: 4</p><p>ntis_number: PB2000-102444</p><p>page_range: 127-138</p><p>primary_author: Kauf, Teresa L</p><p>title: Use of home health care by ESRD and Medicare beneficiaries</p><p>volume: 20</p><p>year_period: 1999 Summer</p>]]></description></item><item><title>National health expenditures, 1989.</title><pubDate>Mon, 04 Nov 2019 02:27:26 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191142</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191142</guid><description><![CDATA[<p>abstract: Spending for health care in the United States grew to $604.1 billion in 1989, an increase of 11.1 percent from the 1988 level. Growth in national health expenditures has been edging upward since 1986, when the annual growth in the health care bill was 7.7 percent. Health care spending continues to command a larger and larger proportion of the resources of the Nation: In 1989, 11.6 percent of the Nation's output, as measured by the gross national product, was consumed by health care, up from 11.2 percent in 1988.</p><p>authors: Letsch, Suzanne W</p><p>issue_mesh: Actuarial Analysis : Aged : Female : Health Expenditures/statistics &#x26; numerical data/trends : Hospitalization/economics : Human : Male : Medicaid/statistics &#x26; numerical data : Medicare/statistics &#x26; numerical data : Nursing Homes/economics : Personal Health Services/economics : United States</p><p>issue_number: 2</p><p>ntis_number: PB91-176263</p><p>page_range: 1-26</p><p>primary_author: Lazenby, Helen C</p><p>title: National health expenditures, 1989.</p><p>volume: 12</p><p>year_period: 1990 Winter</p>]]></description></item><item><title>National health expenditures, 1996.</title><pubDate>Mon, 04 Nov 2019 02:27:26 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191516</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191516</guid><description><![CDATA[<p>abstract: The national health expenditures (NHE) series presented in this report for 1960-96 provides a view of the economic history of health care in the United States through spending for health care services and the sources financing that care. In 1996 NHE topped $1 trillion. At the same time, spending grew at the slowest rate, 4.4 percent, ever recorded in the current series. For the first time, this article presents estimates of Medicare managed care payments by type of service, as well as nursing home and home health spending in hospital-based facilities.</p><p>authors: Braden, Bradley R; Cowan, Cathy A; Donham, Carolyn S; Lazenby, Helen C; Long, Anna M; Martin, Anne B; McDonnell, Patricia A; Sensenig, Arthur L; Sivarajan, Lekha; Stewart, Madie W; Stiller, Jean M; Won, Darleen K</p><p>issue_mesh: Economics : Health Expenditures/statistics &#x26; numerical data/trends : Home Care Services/economics : Human : Insurance, Health/economics : Managed Care Programs/economics : Medicare/statistics &#x26; numerical data : Nursing Homes/economics : Prescriptions, Drug/economics : United States</p><p>issue_number: 1</p><p>ntis_number: PB99-109621</p><p>page_range: 161-200</p><p>primary_author: Levit, Katharine R</p><p>title: National health expenditures, 1996.</p><p>volume: 19</p><p>year_period: 1997 Fall</p>]]></description></item><item><title>Social health maintenance organizations' service use and costs, 1985-89.</title><pubDate>Mon, 04 Nov 2019 02:27:26 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191157</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191157</guid><description><![CDATA[<p>abstract: Presented in this article are aggregate utilization and financial data from the four social health maintenance organization (S/HMO) demonstrations that were collected and analyzed as a part of the national evaluation of the S/HMO demonstration project conducted for the Health Care Financing Administration. The S/HMOs, in offering a $6,500 to $12,000 chronic care benefit in addition to the basic HMO benefit package, had higher start up costs and financial losses over the first 5 years than expected, and controlling costs continues to be a challenge to the sites and their sponsors.</p><p>authors: Newcomer, Robert</p><p>issue_mesh: Aged : California : Chronic Disease/economics : Comprehensive Health Care/economics : Financial Management/statistics &#x26; numerical data : Health Expenditures/statistics &#x26; numerical data : Health Maintenance Organizations/economics/utilization : Hospitalization/statistics &#x26; numerical data : Human : Income/statistics &#x26; numerical data : Medicare/utilization : Minnesota : New York City : Oregon : Pilot Projects : Support, U.S. Gov't, Non-P.H.S. : United States</p><p>issue_number: 3</p><p>ntis_number: PB91-201384</p><p>page_range: 37-52</p><p>primary_author: Harrington, Charlene</p><p>title: Social health maintenance organizations' service use and costs, 1985-89.</p><p>volume: 12</p><p>year_period: 1991 Spring</p>]]></description></item><item><title>Cost shifting in a mental health carve-out for the AFDC population.</title><pubDate>Mon, 04 Nov 2019 02:27:26 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191486</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191486</guid><description><![CDATA[<p>abstract: This study tests whether the managed care vendor shifted costs to Medicaid-reimbursed medical care after the start of the mental health carve-out for the Aid to Families with Dependent Children (AFDC) population in Massachusetts. We used claims data over a 4-year period to estimate expenditures for four types of health services, two of which were paid for by the managed care vendor and two by Medicaid. Total per person public expenditures declined by only about 3 percent. Inpatient psychiatric services were replaced by outpatient psychiatric services and some pharmaceuticals, but overall there was little or no evidence of cost shifting to the medical sector. These results are in contrast to what was found in a sample of Medicaid beneficiaries eligible due to a mental health disability.</p><p>authors: Dickey, Barbara; Lindrooth, Richard C</p><p>issue_mesh: Adolescence : Adult : Aid to Families with Dependent Children/utilization : Child : Child, Preschool : Cost Allocation/statistics &#x26; numerical data : Female : Health Expenditures/statistics &#x26; numerical data : Human : Infant : Male : Managed Care Programs/economics/utilization : Massachusetts : Medicaid/organization &#x26; administration/statistics &#x26; numerical data : Mental Disorders/economics : Mental Health Services/economics/utilization : Middle Age : Models, Econometric : Support, U.S. Gov't, P.H.S. : United States</p><p>issue_number: 3</p><p>ntis_number: PB98-110554</p><p>page_range: 95-108</p><p>primary_author: Norton, Edward C</p><p>title: Cost shifting in a mental health carve-out for the AFDC population.</p><p>volume: 18</p><p>year_period: 1997 Spring</p>]]></description></item><item><title>Medicare risk contracting: determinants of market entry.</title><pubDate>Mon, 04 Nov 2019 02:27:26 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191147</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191147</guid><description><![CDATA[<p>abstract: The Tax Equity and Fiscal Responsibility Act (TEFRA) of 1982 made it more attractive for health maintenance organizations (HMOs) and other competitive medical plans to enter into risk contracts with Medicare. Since the start of the TEFRA program in April 1985, more than 160 HMOs have had risk contracts with Medicare under the program. An investigation of factors associated with TEFRA risk-market entry at the end of 1986 revealed that high adjusted average per capita cost payment levels, prior Medicare cost-contract experience, and prior Federal qualification were the most important factors distinguishing market entrants from nonentrants.</p><p>authors: Wallack, Stanley S</p><p>issue_mesh: Tax Equity and Fiscal Responsibility Act : Capitation Fee : Catchment Area (Health) : Contract Services/economics : Economic Competition : Fees, Medical : Health Maintenance Organizations/economics : Medicare/legislation &#x26; jurisprudence/organization &#x26; administration : Models, Statistical : Risk : Support, U.S. Gov't, Non-P.H.S. : United States</p><p>issue_number: 2</p><p>ntis_number: PB91-176263</p><p>page_range: 75-85</p><p>primary_author: Porell, Frank W</p><p>title: Medicare risk contracting: determinants of market entry.</p><p>volume: 12</p><p>year_period: 1990 Winter</p>]]></description></item><item><title>Consumer and professional ratings of the importance of functional status components.</title><pubDate>Mon, 04 Nov 2019 02:27:26 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191520</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191520</guid><description><![CDATA[<p>abstract: As the population ages and chronic disease becomes the more dominant form of illness, measures of functional loss and disability assume greater importance in the assessment of both quality of life and the cost-effectiveness of care. The authors studied the responses of consumers and health care professionals regarding the impact on dependency of various levels of disability. Striking differences in perception were noted, raising concerns about the ability of those providing care to assume that the recipients share their values about what is important. This study makes clear the need for more research on functional outcome measurements that incorporate the values of consumers.</p><p>authors: Finch, Michael; Philp, Ian; Rockwood, Todd</p><p>issue_mesh: Activities of Daily Living : Quality of Life : Aged : Attitude of Health Personnel : Cost-Benefit Analysis : Frail Elderly/psychology/statistics &#x26; numerical data : Health Services Research : Housing for the Elderly : Human : Minnesota : Patient Satisfaction/statistics &#x26; numerical data : Patient-Centered Care : Social Values</p><p>issue_number: 2</p><p>ntis_number: PB99-109639</p><p>page_range: 11-22</p><p>primary_author: Kane, Robert L</p><p>title: Consumer and professional ratings of the importance of functional status components.</p><p>volume: 19</p><p>year_period: 1997 Winter</p>]]></description></item><item><title>Alternative geographic adjustments in Medicare payment to health maintenance organizations.</title><pubDate>Mon, 04 Nov 2019 02:27:26 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191211</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191211</guid><description><![CDATA[<p>abstract: The payment received by a health maintenance organization (HMO) for its Medicare enrollees is proportionate to the average cost of Medicare beneficiaries in that county. However, HMO market share in an area appears to decrease costs in the fee-for-service sector, so that HMOs are paid less. For this and other reasons, alternative payment formulas may be desirable and several are developed in this article. The conceptually simplest location factor would be an input price index. An alternative strategy would also recognize systematic variation in utilization. Utilization rate is regressed on variables such as county population density and physicians per 1,000 persons. The predicted utilization rate times an input price index could serve as a location factor. The value of alternative location factors are presented for specific counties.</p><p>authors: N/A</p><p>issue_mesh: Catchment Area (Health)/economics : Cost Savings/methods : Geography : Health Maintenance Organizations/economics/utilization : Human : Medicare/economics/statistics &#x26; numerical data : Models, Statistical : Rate Setting and Review/methods/statistics &#x26; numerical data : Regression Analysis : Reimbursement Mechanisms/economics/statistics &#x26; numerical data : Support, U.S. Gov't, Non-P.H.S. : United States</p><p>issue_number: 3</p><p>ntis_number: PB2001-105738</p><p>page_range: 97-110</p><p>primary_author: Welch, W Pete</p><p>title: Alternative geographic adjustments in Medicare payment to health maintenance organizations.</p><p>volume: 13</p><p>year_period: 1992 Spring</p>]]></description></item><item><title>Medicaid support of alcohol, drug abuse, and mental health services.</title><pubDate>Mon, 04 Nov 2019 02:27:26 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191191</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191191</guid><description><![CDATA[<p>abstract: Medicaid expenditures for alcohol, drug abuse, and mental health (ADM) services in 1984 were examined for the States of California and Michigan. Persons receiving such services constituted 9 to 10 percent of the total Medicaid population in the two States and accounted for 22 to 23 percent of total Medicaid expenditures. ADM expenditures were 11 to 12 percent of the total. Although the two States had similar proportions of overall expenditures for these services, Michigan appeared to emphasize inpatient psychiatric care, while California emphasized ambulatory and nursing home care. Based on the experience of the two States, national Medicaid expenditures for ADM services exclusive of long-term care were estimated to be $3.5 to $4.9 billion in 1984, two to three times the level suggested by earlier estimates.</p><p>authors: Buck, Jeffrey A</p><p>issue_mesh: Adult : Aged : Alcoholism/economics/rehabilitation : California : Child : Data Collection : Disabled Persons/statistics &#x26; numerical data : Health Expenditures/statistics &#x26; numerical data : Human : Medicaid/statistics &#x26; numerical data : Mental Health Services/economics/utilization : Michigan : Reimbursement Mechanisms : Substance-Related Disorders/economics/rehabilitation : United States</p><p>issue_number: 1</p><p>ntis_number: PB92-128255</p><p>page_range: 117-128</p><p>primary_author: Wright, George E</p><p>title: Medicaid support of alcohol, drug abuse, and mental health services.</p><p>volume: 13</p><p>year_period: 1991 Fall</p>]]></description></item><item><title>Trends in Medicaid prescription drug utilization and payments, 1990-97.</title><pubDate>Mon, 04 Nov 2019 02:27:26 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191570</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191570</guid><description><![CDATA[<p>abstract: The rising cost of prescription drugs has caused public officials to restructure prescription drug coverage and payment policies in Medicaid. This study examines Medicaid utilization and payments for prescription drugs from 1990 to 1997. Medicaid prescription drug payments grew from $4.4 billion in 1990 to almost $12 billion in 1997, representing an average annual increase of 15.3 percent. In 1997 prescription drug payments per recipient were $1,379 for the blind and disabled, more than 10 times the amount for children. These findings will aid policymakers in setting prepaid plan rates for prescription drugs and monitoring access to care in Medicaid.</p><p>authors: Blackwell, Steven; Pine, Penelope L</p><p>issue_mesh: Drug Utilization/economics : Eligibility Determination : Health Expenditures/statistics &#x26; numerical data/trends : Health Services Research/statistics &#x26; numerical data : Human : Insurance, Health, Reimbursement/statistics &#x26; numerical data/trends : Medicaid/statistics &#x26; numerical data/trends : United States : United States Health Care Financing Administration</p><p>issue_number: 3</p><p>ntis_number: PB2000-102916</p><p>page_range: 79-105</p><p>primary_author: Baugh, David K</p><p>title: Trends in Medicaid prescription drug utilization and payments, 1990-97.</p><p>volume: 20</p><p>year_period: 1999 Spring</p>]]></description></item><item><title>Choice of health plan: implications for access and satisfaction.</title><pubDate>Mon, 04 Nov 2019 02:27:26 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191550</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191550</guid><description><![CDATA[<p>abstract: In this article, the authors examine why low-income persons choose a managed care plan and the effects of choice on access and satisfaction, using data from the 1995-96 Kaiser/Commonwealth Five-State Low-Income Survey. Two-thirds of those choosing a managed care plan cited costs or benefits as their primary reason. Logistic regressions indicate that choice of plan had a neutral or positive effect on access and satisfaction. Medicaid enrollees with choice were less likely than those without to have difficulty obtaining particular services, more likely to rate plan quality highly, and less likely to report major problems with plan rules.</p><p>authors: Berk, Marc L</p><p>issue_mesh: Decision Making : Health Services Accessibility : Poverty : Attitude to Health : Consumer Satisfaction/statistics &#x26; numerical data : Demography : Health Care Surveys : Human : Managed Care Programs/standards/utilization : Medicaid/organization &#x26; administration : Policy Making : State Health Plans/organization &#x26; administration : Support, Non-U.S. Gov't : United States</p><p>issue_number: 1</p><p>ntis_number: PB2000-102914</p><p>page_range: 29-43</p><p>primary_author: Schur, Claudia L</p><p>title: Choice of health plan: implications for access and satisfaction.</p><p>volume: 20</p><p>year_period: 1998 Fall</p>]]></description></item><item><title>Medicare Part A utilization and expenditures for psychiatric services: 1995.</title><pubDate>Mon, 04 Nov 2019 02:27:26 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191490</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191490</guid><description><![CDATA[<p>abstract: This study provides an overview of Medicare's current coverage and payment policies regarding hospitalization for psychiatric disorders, and presents new information on demographic, diagnostic, utilization, and expenditure characteristics associated with inpatient psychiatric care among 1995 Medicare beneficiaries. Results suggest that utilization and expenditure patterns for Medicare beneficiaries hospitalized for psychiatric illness in 1995 differ across demographic (e.g., age, sex, race) and diagnostic categories. The implications of these findings for current management of the Medicare program as well as the evolution of Medicare managed care systems for behavioral health services are discussed.</p><p>authors: Hennessy, Kevin D; Lubitz, James; Warren, Joan L</p><p>issue_mesh: Demography : Female : Health Care Surveys : Health Expenditures/statistics &#x26; numerical data : Hospitals, Psychiatric/economics/statistics &#x26; numerical data/utilization : Human : Male : Medicare Part A/statistics &#x26; numerical data/utilization : Mental Health Services/economics/utilization : Patient Admission/statistics &#x26; numerical data : Patient Discharge/statistics &#x26; numerical data : Reimbursement Mechanisms : Skilled Nursing Facilities/economics/utilization : United States</p><p>issue_number: 3</p><p>ntis_number: PB98-110554</p><p>page_range: 177-193</p><p>primary_author: Cano, Carlos</p><p>title: Medicare Part A utilization and expenditures for psychiatric services: 1995.</p><p>volume: 18</p><p>year_period: 1997 Spring</p>]]></description></item><item><title>A resident-based reimbursement system for intermediate care facilities for the mentally retarded.</title><pubDate>Mon, 04 Nov 2019 02:27:26 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191484</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191484</guid><description><![CDATA[<p>abstract: In this article, the authors present a resident-based reimbursement system for intermediate care facilities for the mentally retarded (ICFs-MR), which represent a large and growing proportion of the Medicaid budget. The statistical relationship between resident disability level and the expected cost of caring for the individual is estimated, allowing for the prediction of expected resource use across the population of ICF-MR residents. The system incorporates an indirect cost rate, a base direct care rate (constant across all providers), and an individual-specific direct care rate, based on the expected cost of care.</p><p>authors: Bollen, Kenneth A; Johnsen, Matthew C; Kilpatrick, Kerry E</p><p>issue_mesh: Reimbursement Mechanisms : Disability Evaluation : Health Care Costs/statistics &#x26; numerical data : Health Care Surveys : Human : Intermediate Care Facilities/economics/utilization : Medicaid/statistics &#x26; numerical data/utilization : Mental Retardation/economics : Models, Econometric : North Carolina : Ownership : Rate Setting and Review : Support, Non-U.S. Gov't : United States</p><p>issue_number: 3</p><p>ntis_number: PB98-110554</p><p>page_range: 61-72</p><p>primary_author: Slifkin, Rebecca T</p><p>title: A resident-based reimbursement system for intermediate care facilities for the mentally retarded.</p><p>volume: 18</p><p>year_period: 1997 Spring</p>]]></description></item><item><title>Preventive services for children under Medicaid, 1989 and 1992.</title><pubDate>Mon, 04 Nov 2019 02:27:26 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191540</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191540</guid><description><![CDATA[<p>abstract: Receipt of key preventive services among Medicaid children in four States is examined. Between 1989 and 1992, small-to-moderate improvements in well-child visit and immunization rates were observed. Age, eligibility group, and statewide factors affected these rates. Uniformly low use of preventive dental care was found. These rates were generally higher among children with well-child visits. To understand the full extent of preventive care for children, all Medicaid-financed well-child services should be considered, not just those provided under the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services program. Nonetheless, EPSDT is a critical vehicle for outreach and case management.</p><p>authors: Chawla, Anita J; Gavin, Norma I</p><p>issue_mesh: Child : Medicaid : California : Evaluation Studies : Georgia : Human : Michigan : Preventive Health Services/utilization : Tennessee : United States</p><p>issue_number: 4</p><p>ntis_number: PB2000-102913</p><p>page_range: 25-44</p><p>primary_author: Herz, Elicia J</p><p>title: Preventive services for children under Medicaid, 1989 and 1992.</p><p>volume: 19</p><p>year_period: 1998 Summer</p>]]></description></item><item><title>Cost sharing, supplementary insurance, and health services utilization among the Medicare elderly.</title><pubDate>Mon, 04 Nov 2019 02:27:26 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191590</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191590</guid><description><![CDATA[<p>abstract: This paper investigates the extent to which private supplementary insurance and Medicaid, which vitiate the effect of Medicare cost-sharing, encourage elderly beneficiaries to seek additional medical care. A multivariate model of health services utilization is estimated with the Tobit technique, using the 1976 Health Interview Survey. We find that either private or public supplementation induces greater use of hospital and physician services, though in amounts that vary considerably according to health status. The paper closes with observations on cost savings brought about by Medicare cost-sharing and some implications for equity among beneficiaries.</p><p>authors: Long, Stephen H; Settle, Russell F</p><p>issue_mesh: Insurance, Physician Services : Medicare : Deductibles and Coinsurance : Insurance Benefits : Models, Theoretical : Personal Health Services/utilization : United States</p><p>issue_number: 2</p><p>ntis_number: HRP-0902942</p><p>page_range: 25-31</p><p>primary_author: Link, Charles R</p><p>title: Cost sharing, supplementary insurance, and health services utilization among the Medicare elderly.</p><p>volume: 2</p><p>year_period: 1980 Fall</p>]]></description></item><item><title>Health care indicators.</title><pubDate>Mon, 04 Nov 2019 02:27:25 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191111</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191111</guid><description><![CDATA[<p>abstract: Contained in this regular feature of the journal is a section on each of the following four topics: community hospital statistics; employment, hours, and earnings in the private health sector; health care prices; and national economic indicators.</p><p>authors: Maple, Brenda T; Singer, Naphtale</p><p>issue_mesh: Economics, Hospital/trends : Fees, Medical/trends : Health Expenditures/trends : Health Manpower/utilization : Hospitals, Community/utilization : Statistics : United States</p><p>issue_number: 4</p><p>ntis_number: PB91-105973</p><p>page_range: 169-196</p><p>primary_author: Donham, Carolyn S</p><p>title: Health care indicators.</p><p>volume: 11</p><p>year_period: 1990 Summer</p>]]></description></item><item><title>Health-based payment for HIV/AIDS in Medicaid managed care programs.</title><pubDate>Mon, 04 Nov 2019 02:27:25 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191534</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191534</guid><description><![CDATA[<p>abstract: In recent years, State Medicaid programs have begun adopting health-based payment systems to help ensure quality care for people living with human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS), and to ensure equity for the managed care organizations (MCOs) in which these people are enrolled. In this article, the authors discuss reasons why such payment systems are needed and describe AIDS-specific capitation rates that have been adopted in several State Medicaid waiver programs. The authors also examine comprehensive risk-adjustment systems both within Medicaid and outside the program. Several research questions needing further work are discussed.</p><p>authors: Gamliel, Sandy; Honberg, Lynda</p><p>issue_mesh: Capitation Fee : Health Status Indicators : HIV Infections/economics/therapy : Human : Insurance, Disability : Managed Care Programs/economics/organization &#x26; administration : Medicaid/economics/statistics &#x26; numerical data : Models, Organizational : Patient Advocacy : Program Evaluation : Quality of Health Care : Rate Setting and Review : State Health Plans/economics/organization &#x26; administration : United States : United States Health Care Financing Administration</p><p>issue_number: 3</p><p>ntis_number: PB2000-102912</p><p>page_range: 63-82</p><p>primary_author: Conviser, Richard</p><p>title: Health-based payment for HIV/AIDS in Medicaid managed care programs.</p><p>volume: 19</p><p>year_period: 1998 Spring</p>]]></description></item><item><title>Alternative geographic configurations for Medicare payments to health maintenance organizations.</title><pubDate>Mon, 04 Nov 2019 02:27:25 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191091</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191091</guid><description><![CDATA[<p>abstract: Under prevailing legislation, Medicare payments to health maintenance organizations (HMOs) are based upon projected fee-for-service reimbursement levels for enrollees' county of residence. These rates have been criticized in light of substantial variations in rates among neighboring counties and large fluctuations in rates over time. In this study, the use of nine alternative configurations and the county itself were evaluated on the basis of payment-area homogeneity, payment rate stability, and policy criteria, including the fiscal impacts of reconfiguration on HMOs. The results revealed rather modest differences among most alternative configurations and do not lend strong support for payment area reconfiguration at this time.</p><p>authors: Tompkins, Christopher P; Turner, Winston M</p><p>issue_mesh: Analysis of Variance : Catchment Area (Health)/economics : Data Collection : Evaluation Studies : Health Maintenance Organizations/economics : Medicare/organization &#x26; administration : Models, Theoretical : Rate Setting and Review/methods : Reimbursement Mechanisms/organization &#x26; administration : Research Design : Support, U.S. Gov't, Non-P.H.S. : United States</p><p>issue_number: 3</p><p>ntis_number: PB90-258153</p><p>page_range: 17-30</p><p>primary_author: Porell, Frank W</p><p>title: Alternative geographic configurations for Medicare payments to health maintenance organizations.</p><p>volume: 11</p><p>year_period: 1990 Spring</p>]]></description></item><item><title>National health expenditures: short-term outlook and long-term projections.</title><pubDate>Mon, 04 Nov 2019 02:27:25 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191599</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191599</guid><description><![CDATA[<p>abstract: This paper presents projections of national health expenditures by type of expenditure and source of funds for 1981, 1985, and 1990. Rapid growth in national health expenditures is projected to continue through 1990. National health expenditures increased 400 percent between 1965 and 1979, reaching $212 billion in 1979. As a proportion of the Gross National Product (GNP), health expenditures rose from 6.1 percent to 9.0 percent between 1965 and 1979. They are expected to continue to rise, reaching 10.8 percent by 1990. This study projects that, under current legislation, national health expenditures will research $279 billion in 1981, $462 billion in 1985, and $821 billion in 1990. Sources of payments for these expenditures are shifting. From 1965 to 1979, the percentage of total health expenditures financed by public funds increased 17 percentage points--from 26 to 43 percent. The Federal share of public funds during this same period grew rapidly, from 51 percent in 1965 to 67 percent in 1979. This study projects that in 1985 approximately 45 percent of total health spending will be financed from public funds, of which 68 percent will be paid for by the Federal government. Public funds will account for 46 percent of total national health expenditure by 1990.</p><p>authors: Schendler, Carol E</p><p>issue_mesh: Forecasting : Financing, Government/trends : Health Expenditures/trends : United States</p><p>issue_number: 3</p><p>ntis_number: HRP0903015</p><p>page_range: 97-138</p><p>primary_author: Freeland, Mark S</p><p>title: National health expenditures: short-term outlook and long-term projections.</p><p>volume: 2</p><p>year_period: 1981 Winter</p>]]></description></item><item><title>Measuring the health status of Medicare beneficiaries: 1995.</title><pubDate>Mon, 04 Nov 2019 02:27:25 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191504</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191504</guid><description><![CDATA[<p>authors: Poisal, John A</p><p>issue_mesh: Health Status Indicators : Activities of Daily Living : Aged : Health Care Surveys : Human : Medicare/utilization : Self Assessment (Psychology) : United States</p><p>issue_number: 4</p><p>ntis_number: PB99-109613</p><p>page_range: 125-131</p><p>primary_author: Eppig, Franklin J</p><p>title: Measuring the health status of Medicare beneficiaries: 1995.</p><p>volume: 18</p><p>year_period: 1997 Summer</p>]]></description></item><item><title>Medicaid providers of children's perspective and EPSDT services, 1989 and 1992.</title><pubDate>Mon, 04 Nov 2019 02:27:25 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191539</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191539</guid><description><![CDATA[<p>abstract: In this study, the authors use 1989 and 1992 Medicaid Tape-to-Tape data from California, Georgia, Michigan, and Tennessee to examine changes in provider systems before and after enactment of the Omnibus Budget Reconciliation Act of 1989 (OBRA 89). Although all four study States' preventive and Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services provider system grew, Michigan's growth was markedly higher. Growth occurred in the number of both office-based and clinic-based providers. However, this growth was outpaced by growth in enrollment, so that child/provider ratios were generally higher at the end of the study period.</p><p>authors: Graver, Linda J</p><p>issue_mesh: Child : Medicaid : California : Evaluation Studies : Georgia : Human : Michigan : Preventive Health Services/utilization : Tennessee : United States</p><p>issue_number: 4</p><p>ntis_number: PB2000-102913</p><p>page_range: 5-23</p><p>primary_author: Adams, E Kathleen</p><p>title: Medicaid providers of children's perspective and EPSDT services, 1989 and 1992.</p><p>volume: 19</p><p>year_period: 1998 Summer</p>]]></description></item><item><title>Medicaid payment rates for nursing homes, 1979-86.</title><pubDate>Mon, 04 Nov 2019 02:27:25 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191145</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191145</guid><description><![CDATA[<p>abstract: The issue of the cost containment effects of payment systems on per diem payments by Medicaid to nursing homes is addressed. Estimates of real payment rates as a function of broadly defined payment system classifications and economic and demographic variables using State-level data are presented. Little support for the notion that prospective payment systems substantially restrain payment rates for intermediate care facilities is found, but some model specifications indicate possible cost savings associated with prospective payment systems for skilled nursing facilities. Significant methodological concerns that need to be addressed in future research on the cost containment effects of payment systems are also discussed.</p><p>authors: Ohsfeldt, Robert L</p><p>issue_mesh: Cost Control : Intermediate Care Facilities/economics : Medicaid/statistics &#x26; numerical data : Nursing Homes/economics : Prospective Payment System/statistics &#x26; numerical data : Rate Setting and Review/trends : Skilled Nursing Facilities/economics : United States</p><p>issue_number: 2</p><p>ntis_number: PB91-176263</p><p>page_range: 55-66</p><p>primary_author: Gohmann, Stephan F</p><p>title: Medicaid payment rates for nursing homes, 1979-86.</p><p>volume: 12</p><p>year_period: 1990 Winter</p>]]></description></item><item><title>Medicare episodes of illnesses: a study of hospital, skilled nursing facility, and home health agency care.</title><pubDate>Mon, 04 Nov 2019 02:27:25 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191589</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191589</guid><description><![CDATA[<p>abstract: This paper analyzes charges incurred under the Medicare program for inpatient hospital, skilled nursing facility (SNF), and home health agency (HHA) care for 1976. This research was made possible through the construction of a new data set which links a beneficiary's use of these three services. Summary highlights reveal that an overwhelming majority of the 7.5 million Medicare episodes of illness do not involve post-hospital SNF or HHA care. Those episodes of illness that use only hospital care are substantially (53%) cheaper than all other episodes. A large percentage of these charge differences reflect the greater number of hospital days of care associated with post-hospital care services. However, an analysis of the beneficiaries' demographic characteristics suggests that persons who use post-hospital care generally differ from those who receive only hospital care. We found that persons who use post-hospital SNF or HHA, or both types of care are likely to be female, to have cancer, diabetes, fractured bones or a central nervous or vascular system disease, and to be older than persons who do not use these types of care. The data also show that a beneficiary's area of residence greatly influences the amount and types of care received. Persons who reside in the New England, Middle Atlantic and Pacific Divisions are more likely to receive post-hospital care services than person who live elsewhere in the United States. These persons also incur among the highest per capita institutional charges in the United States. Part of this variation in institutional charges per capita is explained by the high input price index found in these areas, and in some cases by the high quantity of services index.</p><p>authors: Fisher, Charles R</p><p>issue_mesh: Age Factors : Aged : Fees and Charges : Female : Home Care Services/utilization : Hospitals/utilization : Human : Insurance, Health, Reimbursement : Male : Medicare/economics : Sex Factors : Skilled Nursing Facilities/utilization : Statistics : United States</p><p>issue_number: 2</p><p>ntis_number: HRP-0902942</p><p>page_range: 1-24</p><p>primary_author: Young, Karen M</p><p>title: Medicare episodes of illnesses: a study of hospital, skilled nursing facility, and home health agency care.</p><p>volume: 2</p><p>year_period: 1980 Fall</p>]]></description></item><item><title>Drug use and prescribing problems in four state Medicaid programs.</title><pubDate>Mon, 04 Nov 2019 02:27:25 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191569</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191569</guid><description><![CDATA[<p>abstract: In this article the authors present population-level prevalence rates for 61 specific drug-related problems occurring in three State Medicaid programs (Maryland, Iowa, and Washington) from 1989 through 1996 and a fourth (Georgia) from 1994 through 1996. The findings represent the first application of a consistent drug utilization review (DUR) screener program to Medicaid data across States. The study finds major differences in DUR failure rates among the four States with the lowest rates in Georgia and the highest in Washington. Only Iowa showed any population-level reduction in DUR failure rates during the study period, however, rates for community-dwelling elderly fell in most States.</p><p>authors: Ahern, Frank; Briesacher, Becky A; Erwin, Gary; Fahlman, Cheryl; Gilden, Daniel; Kidder, David; Zacker, Christopher</p><p>issue_mesh: Drug Therapy/adverse effects/classification : Drug Utilization/statistics &#x26; numerical data : Georgia : Health Services Research : Human : Insurance Claim Review : Iowa : Maryland : Medicaid/statistics &#x26; numerical data : State Health Plans/organization &#x26; administration : Support, U.S. Gov't, Non-P.H.S. : United States : Washington</p><p>issue_number: 3</p><p>ntis_number: PB2000-102916</p><p>page_range: 63-78</p><p>primary_author: Stuart, Bruce</p><p>title: Drug use and prescribing problems in four state Medicaid programs.</p><p>volume: 20</p><p>year_period: 1999 Spring</p>]]></description></item><item><title>Patient centered long-term care.</title><pubDate>Mon, 04 Nov 2019 02:27:25 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191519</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191519</guid><description><![CDATA[<p>abstract: Drawing upon an individual's needs, values, and expectations to guide decisionmaking and care giving is integral to long-term care (LTC). Articles in this issue demonstrate that client values and preferences can be elicited and used to guide decisionmaking about LTC. Service delivery and payment features can be shaped to support the patient/consumer, as well as to support and strengthen her or his informal caregivers. Significant constraints to making LTC more client centered are also identified. Key issues relate to the availability of and methods to process information as well as pressures on provider staff that impede their ability to support clients and their families. More broadly, access to appropriate LTC services is being shaped by programmatic shifts and legal forces that may enhance or impede the ability to place patients/clients at the center of LTC.</p><p>authors: N/A</p><p>issue_mesh: Activities of Daily Living : Caregivers : Conflict (Psychology) : Decision Making : Health Personnel : Health Services Accessibility : Long-Term Care/organization &#x26; administration : Negotiating : Patient Participation : Patient-Centered Care/organization &#x26; administration : Professional Competence : Quality of Life : United States</p><p>issue_number: 2</p><p>ntis_number: PB99-109639</p><p>page_range: 1-10</p><p>primary_author: Miller, Nancy A</p><p>title: Patient centered long-term care.</p><p>volume: 19</p><p>year_period: 1997 Winter</p>]]></description></item><item><title>Impact of Medicare SELECT on cost and utilization in 11 states.</title><pubDate>Mon, 04 Nov 2019 02:27:25 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191509</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191509</guid><description><![CDATA[<p>abstract: In this article, the authors evaluate the cost and utilization effects of the SELECT implementations in 11 States. In particular they compare the before-and-after enrollment experiences of Medicare beneficiaries newly enrolled in SELECT plans with the experiences of those newly enrolled in traditional medigap plans. Using Medicare claims data for 1991 through 1994, the authors find that Medicare SELECT increased costs in five States, decreased costs in three States, and had no effect in three States. Cost increases were generally related to Part B utilization.</p><p>authors: Garfinkel, Steven A; Khandker, Rezaul K; Norton, Edward C</p><p>issue_mesh: Aged : Community Networks/economics/organization &#x26; administration : Comparative Study : Cost Control : Female : Health Expenditures/trends : Health Services Needs and Demand/statistics &#x26; numerical data : Human : Insurance, Medigap/statistics &#x26; numerical data/utilization : Male : Managed Care Programs/economics/utilization : Medicare Part B/statistics &#x26; numerical data/utilization : United States</p><p>issue_number: 1</p><p>ntis_number: PB99-109621</p><p>page_range: 19-40</p><p>primary_author: Lee, A James</p><p>title: Impact of Medicare SELECT on cost and utilization in 11 states.</p><p>volume: 19</p><p>year_period: 1997 Fall</p>]]></description></item><item><title>Improving hospital discharge planning for elderly patients.</title><pubDate>Mon, 04 Nov 2019 02:27:25 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191522</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191522</guid><description><![CDATA[<p>abstract: Hospital discharge planning has become increasingly important in an era of prospective payment and managed care. Given the changes in tasks, decisions, and environments involved, it is important to identify how to move such planning from an art to an empirically based decisionmaking process. The authors use a decision-sciences framework to review the state-of-the-art of hospital discharge planning and to suggest methods for improvement.</p><p>authors: Franco, Sheila J; Kane, Robert L</p><p>issue_mesh: Decision Making, Organizational : Geriatric Assessment : Activities of Daily Living : Aged : Contract Services/organization &#x26; administration : Health Services Research : Home Care Services/standards : Human : Nursing Homes/standards : Outcome Assessment (Health Care) : Patient Discharge/standards : Quality Assurance, Health Care : Recovery of Function : Support, Non-U.S. Gov't</p><p>issue_number: 2</p><p>ntis_number: PB99-109639</p><p>page_range: 47-72</p><p>primary_author: Potthoff, Sandra</p><p>title: Improving hospital discharge planning for elderly patients.</p><p>volume: 19</p><p>year_period: 1997 Winter</p>]]></description></item><item><title>Caregiver supports: outcomes from the Medicare Alzheimer's disease demonstration.</title><pubDate>Mon, 04 Nov 2019 02:27:25 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191524</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191524</guid><description><![CDATA[<p>abstract: A randomized 3-year study assessed the effect of expanded community-based services and case management on 5,254 caregivers of dementia clients. A tested policy concern was whether the financing of formal care would result in a reduction of informal assistance. Unmet needs task assistance for the demonstration's treatment group caregivers decreased by 30 percent within 6 months and by about 20 percent over 36 months relative to controls. While treatment group members used slightly more formal care over time, there were no differences between treatment and control groups in primary caregiver hours after 36 months, or in the number of tasks in which primary or secondary caregivers provided assistance.</p><p>authors: Bostrom, Alan; DuNah Jr, Richard; Fox, Patrick; Newcomer, Robert; Wilkinson, Anne</p><p>issue_mesh: Social Support : Activities of Daily Living : Aged : Alzheimer Disease/economics/nursing : Caregivers/psychology : Case Management : Data Interpretation, Statistical : Financing, Government : Health Services Research/methods : Human : Medicare/utilization : Needs Assessment : Outcome Assessment (Health Care) : Pilot Projects : Stress, Psychological : Support, U.S. Gov't, Non-P.H.S. : United States : United States Health Care Financing Administration</p><p>issue_number: 2</p><p>ntis_number: PB99-109639</p><p>page_range: 97-117</p><p>primary_author: Yordi, Cathleen L</p><p>title: Caregiver supports: outcomes from the Medicare Alzheimer's disease demonstration.</p><p>volume: 19</p><p>year_period: 1997 Winter</p>]]></description></item><item><title>Managing access: extending Medicaid to children through school-based HMO coverage.</title><pubDate>Mon, 04 Nov 2019 02:27:25 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191489</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191489</guid><description><![CDATA[<p>abstract: This study explores how a health maintenance organization's (HMO) capacity and incentives to manage care might be used to improve access. In the early 1990s, the Florida Healthy Kids (FHK) demonstration extended Medicaid-like HMO coverage to indigent children in the public schools of Volusia County, Florida. The study finds that uninsured student months in area public schools were likely reduced by one-half. Utilization and cost levels for these indigent enrollees proved to be indistinguishable from commercial clients; and measures of access, utilization, and satisfaction for enrollees were in line with (and in some cases, superior to) non-enrollees with private insurance. Overall, these results suggest the value of using schools as a medium for providing coverage, and the importance of taking deliberate steps to manage access to reduce non-financial barriers to care.</p><p>authors: Calore, Kathleen A; Irvin, Carol V; Kidder, David; Rosenbach, Margo L</p><p>issue_mesh: Health Services Accessibility : Child : Child Health Services/economics/utilization : Eligibility Determination : Emergency Service, Hospital/utilization : Florida : Health Care Costs : Health Care Surveys : Health Maintenance Organizations/economics/utilization : Health Services Needs and Demand : Human : Medicaid/statistics &#x26; numerical data/utilization : Medical Indigency : Pilot Projects : Poverty : School Health Services/economics/utilization : Support, U.S. Gov't, P.H.S. : United States</p><p>issue_number: 3</p><p>ntis_number: PB98-110554</p><p>page_range: 149-175</p><p>primary_author: Coulam, Robert F</p><p>title: Managing access: extending Medicaid to children through school-based HMO coverage.</p><p>volume: 18</p><p>year_period: 1997 Spring</p>]]></description></item><item><title>Trends in Medicare supplementary insurance: 1992-96.</title><pubDate>Mon, 04 Nov 2019 02:27:25 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191517</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191517</guid><description><![CDATA[<p>authors: Chulis, George S</p><p>issue_mesh: Aged : Disabled Persons : Fee-for-Service Plans/economics : Human : Insurance Coverage/statistics &#x26; numerical data : Managed Care Programs/economics : Medicare Part B/statistics &#x26; numerical data/trends : Social Class : United States</p><p>issue_number: 1</p><p>ntis_number: PB99-109621</p><p>page_range: 201-206</p><p>primary_author: Eppig, Franklin J</p><p>title: Trends in Medicare supplementary insurance: 1992-96.</p><p>volume: 19</p><p>year_period: 1997 Fall</p>]]></description></item><item><title>Impact of report cards on employees: a natural experiment.</title><pubDate>Mon, 04 Nov 2019 02:27:25 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191549</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191549</guid><description><![CDATA[<p>abstract: To determine the effect of survey-based, health plan report cards on employees as they selected their 1995 health plan, the authors surveyed two groups of Minnesota State employees, one of which received the report card and one that did not. Both groups were surveyed before and after their enrollment. The authors looked for report card effects on relative changes in the employees' knowledge of health plan benefits and their ratings of quality and cost attributes, as well as their plan choice, rates of switching plans, and willingness to pay higher premiums. The only report card effect found was an increase in perceived knowledge for employees with single coverage.</p><p>authors: Adlis, Susan; Fowles, Jinnet B; Kind, Elizabeth A</p><p>issue_mesh: Decision Making : Consumer Satisfaction/statistics &#x26; numerical data : Costs and Cost Analysis : Data Collection : Economic Competition : Health Benefit Plans, Employee/economics/standards/utilization : Health Care Surveys : Health Maintenance Organizations/economics/standards/utilization : Information Services/utilization : Knowledge, Attitudes, Practice : Minnesota : Quality Assurance, Health Care : Questionnaires : Support, U.S. Gov't, Non-P.H.S.</p><p>issue_number: 1</p><p>ntis_number: PB2000-102914</p><p>page_range: 5-27</p><p>primary_author: Knutson, David J</p><p>title: Impact of report cards on employees: a natural experiment.</p><p>volume: 20</p><p>year_period: 1998 Fall</p>]]></description></item><item><title>Predictors of functional health status of end stage renal disease patients.</title><pubDate>Mon, 04 Nov 2019 02:27:25 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191499</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191499</guid><description><![CDATA[<p>abstract: Potential predictors of the functional health status of 125 end stage renal disease (ESRD) patients were studied cross-sectionally. When health status was assessed by the physician with the Karnofsky Index, younger patient age, lower ESRD severity of illness, lower comorbidity severity, and higher albumin levels were predictors of better health [R-square = 0.48]. When patients self-reported their health status with the Duke Health Profile, African-American race, higher family support, lower family stress, and lower ESRD severity were positive predictors [R-square = 0.23]. The importance of measuring functional status, severity of illness, and social support and stress of ESRD patients is supported by these findings.</p><p>authors: Gutman, Robert A</p><p>issue_mesh: Health Status Indicators : Self Assessment (Psychology) : Chi-Square Distribution : Comorbidity : Cross-Sectional Studies : Hemodialysis/psychology : Human : Karnofsky Performance Status : Kidney Failure, Chronic/classification/psychology : North Carolina : Questionnaires : Rural Population : Severity of Illness Index : Social Support : Stress, Psychological : Support, Non-U.S. Gov't : Urban Population</p><p>issue_number: 4</p><p>ntis_number: PB99-109613</p><p>page_range: 37-49</p><p>primary_author: Parkerson, George R</p><p>title: Predictors of functional health status of end stage renal disease patients.</p><p>volume: 18</p><p>year_period: 1997 Summer</p>]]></description></item><item><title>Health care expenditure and other data.</title><pubDate>Mon, 04 Nov 2019 02:27:25 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191068</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191068</guid><description><![CDATA[<p>ntis_number: PB90-172255</p><p>page_range: 111-194</p><p>primary_author: Poullier, Jean P</p><p>title: Health care expenditure and other data.</p><p>volume: Supp.</p><p>year_period: 1989 Supp.</p>]]></description></item><item><title>Cost containment in Europe.</title><pubDate>Mon, 04 Nov 2019 02:27:25 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191064</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191064</guid><description><![CDATA[<p>ntis_number: PB90-172255</p><p>page_range: 21-32</p><p>primary_author: Culyer, A J</p><p>title: Cost containment in Europe.</p><p>volume: Supp.</p><p>year_period: 1989 Supp.</p>]]></description></item><item><title>Analysis of variations in hospital use by Medicare patients in PSRO areas, 1974-1977.</title><pubDate>Mon, 04 Nov 2019 02:27:24 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191047</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191047</guid><description><![CDATA[<p>abstract: A study of the use of short-stay hospitals in PSRO areas by Medicare enrollees aged 65 and over for the period 1974 through 1977 revealed that discharge rates increased, average length of stay (ALOS) decreased, and days-of-care rates remained relatively constant in nearly all of the PSRO areas. The data show large variations in hospital use in PSRO areas within States and HEW regions, and suggest that factors within the area are critical determinants of hospital utilization. This study presents important implications for PSRO program policy for it suggests that factors other than physician and hospital behavior should also be considered when setting objectives for reducing misutilization and improving the quality of health care.</p><p>authors: Gornick, Marian; Lubitz, James; Newton, Marilyn</p><p>issue_mesh: Catchment Area (Health) : Aged : Female : Hospitalization/trends : Human : Length of Stay/trends : Male : Medicare/utilization : Patient Discharge : Population : Professional Review Organizations/organization &#x26; administration : Statistics : United States</p><p>issue_number: 1</p><p>ntis_number: PB81-112799</p><p>page_range: 79-107</p><p>primary_author: Deacon, Ronald W</p><p>title: Analysis of variations in hospital use by Medicare patients in PSRO areas, 1974-1977.</p><p>volume: 1</p><p>year_period: 1979 Summer</p>]]></description></item><item><title>Stability of disability among PACE enrollees: financial and programmatic implications.</title><pubDate>Mon, 04 Nov 2019 02:27:24 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191535</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191535</guid><description><![CDATA[<p>abstract: This article examines the experience of the first 11 Program of All-inclusive Care for the Elderly (PACE) programs. It investigates changes in functional status of participants in relation to length of enrollment in the program and individual risk characteristics. Our findings indicate that mature programs experience stable disability mix over time, supporting the rationale for the current PACE payment method. However, significant differences exist between programs, suggesting that payment rates could be more program specific. Analysis of the effect of patient characteristics at admission on the likelihood of improvement in functional status identified areas for quality improvement. The implications of this study have increasing importance in light of the expected expansion of PACE to approximately 100 sites by the year 2000.</p><p>authors: Clark, Marleen L; Temkin-Greener, Helena</p><p>issue_mesh: Capitation Fee : Disabled Persons : Activities of Daily Living : Aged : Comprehensive Health Care/economics/organization &#x26; administration : Diagnosis-Related Groups : Health Maintenance Organizations/economics : Health Services for the Aged/economics/organization &#x26; administration : Human : Long-Term Care/economics/organization &#x26; administration : Medicaid/economics : Medicare/economics : Pilot Projects : Program Evaluation : Quality of Health Care : Recovery of Function : Risk Factors : Support, Non-U.S. Gov't : United States</p><p>issue_number: 3</p><p>ntis_number: PB2000-102912</p><p>page_range: 83-100</p><p>primary_author: Mukamel, Dana B</p><p>title: Stability of disability among PACE enrollees: financial and programmatic implications.</p><p>volume: 19</p><p>year_period: 1998 Spring</p>]]></description></item><item><title>Overview: Access to health services for vulnerable populations.</title><pubDate>Mon, 04 Nov 2019 02:27:24 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191402</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191402</guid><description><![CDATA[<p>abstract: This overview discusses articles published in this issue of the Health Care Financing Review, entitled "Access to health services for vulnerable populations." These articles focus on the following topics: access to Medicaid for pregnant women, access measures by health status, racial access questions, end stage renal disease (ESRD) patients, other special populations, and the effects of physician payment reform.</p><p>authors: N/A</p><p>issue_mesh: Health Services Accessibility : Socioeconomic Factors : United States : United States Health Care Financing Administration</p><p>issue_number: 2</p><p>ntis_number: PB96-172663</p><p>page_range: 1-6</p><p>primary_author: Mentnech, Renee M</p><p>title: Overview: Access to health services for vulnerable populations.</p><p>volume: 17</p><p>year_period: 1995 Winter</p>]]></description></item><item><title>Impact of Medicaid expansion on early prenatal care and health outcomes.</title><pubDate>Mon, 04 Nov 2019 02:27:24 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191543</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191543</guid><description><![CDATA[<p>abstract: To assess the impact of Medicaid expansion for pregnant women in South Carolina and California, the authors compared change in rates of timely prenatal care, adverse infant and maternal health outcomes, and use of cesarean section for groups of pregnant women who were either uninsured or covered by Medicaid, versus women with private coverage. The result showed small and/or inconsistent changes. Provision of coverage may be the first logical step in improving health care for the uninsured, but outcomes may rely more on outreach, coordination of care, and non-medical interventions than on provision of insurance coverage per se.</p><p>authors: Newhouse, Joseph P</p><p>issue_mesh: Maternal Health Services : Prenatal Care/utilization : California : Cesarean Section/utilization : Comparative Study : Human : Infant, Newborn : Outcome Assessment (Health Care) : Unites States</p><p>issue_number: 4</p><p>ntis_number: PB2000-102913</p><p>page_range: 85-99</p><p>primary_author: Epstein, Arnold M</p><p>title: Impact of Medicaid expansion on early prenatal care and health outcomes.</p><p>volume: 19</p><p>year_period: 1998 Summer</p>]]></description></item><item><title>Determining consumer preferences for a cash option: Arkansas survey results.</title><pubDate>Mon, 04 Nov 2019 02:27:24 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191523</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191523</guid><description><![CDATA[<p>abstract: As long-term care (LTC) expenditures have risen, policymakers have sought ways to control costs while maintaining consumer satisfaction. Concurrently, there is increasing interest within the aging and disability communities in consumer-directed care. The Cash and Counseling Demonstration and Evaluation (CCDE) seeks to increase consumer direction and control costs by offering a cash allowance and information services to persons with disabilities, enabling them to purchase needed assistance. The authors present results from a telephone survey conducted to assess consumer preferences for a cash option in Arkansas and describe how findings from the four-State CCDE can inform consumer information efforts and policymakers.</p><p>authors: Desmond, Sharon M; Fay, Robert A; Mahoney, Kevin J; Shoop, Dawn M; Squillace, Marie R</p><p>issue_mesh: Consumer Satisfaction : Disabled Persons : Health Services Accessibility : Arkansas : Cost Control : Data Collection : Demography : Health Policy : Health Services Research/methods : Personal Health Services/economics : Program Evaluation : Support, Non-U.S. Gov't : Support, U.S. Gov't, Non-P.H.S.</p><p>issue_number: 2</p><p>ntis_number: PB99-109639</p><p>page_range: 73-96</p><p>primary_author: Simon-Rusinowitz, Lori</p><p>title: Determining consumer preferences for a cash option: Arkansas survey results.</p><p>volume: 19</p><p>year_period: 1997 Winter</p>]]></description></item><item><title>What Medicare has meant to older Americans.</title><pubDate>Mon, 04 Nov 2019 02:27:24 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191468</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191468</guid><description><![CDATA[<p>authors: N/A</p><p>issue_mesh: Aged : Health Expenditures/statistics &#x26; numerical data : Health Services Accessibility/statistics &#x26; numerical data : Health Services for the Aged/economics/statistics &#x26; numerical data/utilization : Human : Income : Insurance, Health, Reimbursement/statistics &#x26; numerical data : Insurance, Health/statistics &#x26; numerical data : Insurance, Medigap/statistics &#x26; numerical data : Medicare/statistics &#x26; numerical data/trends/utilization : Program Evaluation : United States : Universal Coverage</p><p>issue_number: 2</p><p>ntis_number: PB98-110885</p><p>page_range: 49-59</p><p>primary_author: Moon, Marilyn</p><p>title: What Medicare has meant to older Americans.</p><p>volume: 18</p><p>year_period: 1996 Winter</p>]]></description></item><item><title>Patterns of health maintenance organization service areas in rural counties.</title><pubDate>Mon, 04 Nov 2019 02:27:24 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191393</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191393</guid><description><![CDATA[<p>abstract: This study analyzes the 1993 National Directory of HMOs to determine the extent to which rural counties are included in health maintenance organization (HMO) service areas. Two specific questions are addressed: (1) How do the patterns of service areas differ across HMO model types? (2) What are the characteristics that distinguish rural counties served by HMOs from those that are not? Although a majority of rural counties are in HMO service areas, substantially fewer are served by non-individual practice association (non-IPA) models. Access to HMO services is found to decrease with county population density, and adjacency to metropolitan areas is an important predictor of inclusion in service areas.</p><p>authors: Johnson-Webb, Karen D; Slifkin, Rebecca T</p><p>issue_mesh: Catchment Area (Health)/statistics &#x26; numerical data : Health Care Costs/standards : Health Maintenance Organizations/economics/statistics &#x26; numerical data : Health Services Accessibility/standards : Models, Organizational : Rural Health Services/economics/supply &#x26; distribution/statistics &#x26; numerical data : Support, U.S. Gov't, P.H.S. : United States</p><p>issue_number: 1</p><p>ntis_number: PB96-139548</p><p>page_range: 99-113</p><p>primary_author: Ricketts 3d, Thomas C</p><p>title: Patterns of health maintenance organization service areas in rural counties.</p><p>volume: 17</p><p>year_period: 1995 Fall</p>]]></description></item><item><title>Issues in rural health: access, hospitals, and reform.</title><pubDate>Mon, 04 Nov 2019 02:27:24 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191387</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191387</guid><description><![CDATA[<p>abstract: This overview discusses articles published in this issue of the Health Care Financing Review, entitled "Access to Health Care Services in Rural Areas: Delivery and Financing Issues." These articles focus on the following topics: rural hospitals (including closures, the impact of Federal grants, network development, and costs), managed care in rural areas, telemedicine, and the delivery of mental health services to rural Medicaid beneficiaries.</p><p>authors: N/A</p><p>issue_mesh: Cost-Benefit Analysis : Health Care Reform/economics/standards : Health Services Accessibility/standards : Hospitals, Rural/economics/supply &#x26; distribution : Managed Care Programs/economics/standards : Medicaid/economics : Medicare/economics : Mental Health Services/economics/standards : Rural Health Services/economics/supply &#x26; distribution : Telemedicine/economics/standards : United States</p><p>issue_number: 1</p><p>ntis_number: PB96-139548</p><p>page_range: 1-14</p><p>primary_author: Weisgrau, Sheldon</p><p>title: Issues in rural health: access, hospitals, and reform.</p><p>volume: 17</p><p>year_period: 1995 Fall</p>]]></description></item><item><title>Hospital, employment, and price indicators for the health care industry: third quarter 1997.</title><pubDate>Mon, 04 Nov 2019 02:27:24 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191537</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191537</guid><description><![CDATA[<p>abstract: This regular feature of the journal includes a discussion of each of the following four topics: community hospital statistics; employment, hours, and earnings in the private health sector; health care prices; and national economic indicators. These statistics are valuable in their own right for understanding the relationship between the health care sector and the overall economy. In addition, they allow us to anticipate the direction and magnitude of health care cost changes prior to the availability of more comprehensive data.</p><p>authors: Donham, Carolyn S; Heffler, Stephen K</p><p>issue_mesh: Data Collection : Employment/statistics &#x26; numerical data/trends : Health Care Sector/statistics &#x26; numerical data : Health Expenditures/statistics &#x26; numerical data/trends : Health Personnel/economics : Hospitals, Community/statistics &#x26; numerical data/trends : Length of Stay/statistics &#x26; numerical data/trends : Salaries and Fringe Benefits/statistics &#x26; numerical data/trends : United States</p><p>issue_number: 3</p><p>ntis_number: PB2000-102912</p><p>page_range: 105-149</p><p>primary_author: Seifert, Mary L</p><p>title: Hospital, employment, and price indicators for the health care industry: third quarter 1997.</p><p>volume: 19</p><p>year_period: 1998 Spring</p>]]></description></item><item><title>Changing patterns of Surgical care in the United States, 1980-1995</title><pubDate>Mon, 04 Nov 2019 02:27:24 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191609</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191609</guid><description><![CDATA[<p>page_range: 31-49</p><p>primary_author: Kozak, Lola J</p><p>title: Changing patterns of Surgical care in the United States, 1980-1995</p><p>volume: 21</p><p>year_period: 1999 Fall</p>]]></description></item><item><title>State implementation of the AIDS drug assistance programs.</title><pubDate>Mon, 04 Nov 2019 02:27:24 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191533</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191533</guid><description><![CDATA[<p>abstract: Acquired immunodeficiency syndrome (AIDS) drug assistance programs (ADAPs) provide access to medications for people who lack other health coverage. In this article, the authors present the results of a 1997 survey identifying how 48 States implemented ADAPs, focusing on the number of beneficiaries, medical and financial eligibility criteria, the administration of waiting lists, and the coverage of drugs including protease inhibitors. Increased funding for ADAPs is necessary to maintain this important part of the public sector safety net for human immunodeficiency virus (HIV) care.</p><p>authors: Smith, Scott R</p><p>issue_mesh: Insurance Coverage : Acquired Immunodeficiency Syndrome/drug therapy/economics : Anti-HIV Agents/economics/therapeutic use : Eligibility Determination : Formularies : HIV Protease Inhibitors/economics/therapeutic use : Human : Medical Assistance/economics/legislation &#x26; jurisprudence/organization &#x26; administration : Medically Uninsured : Program Evaluation/statistics &#x26; numerical data : State Health Plans : Support, U.S. Gov't, Non-P.H.S. : United States : Waiting Lists</p><p>issue_number: 3</p><p>ntis_number: PB2000-102912</p><p>page_range: 39-62</p><p>primary_author: Buchanan, Robert J</p><p>title: State implementation of the AIDS drug assistance programs.</p><p>volume: 19</p><p>year_period: 1998 Spring</p>]]></description></item><item><title>Children's preventive care under two mature Medicaid managed care plans in California.</title><pubDate>Mon, 04 Nov 2019 02:27:24 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191542</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191542</guid><description><![CDATA[<p>abstract: We investigated the extent to which children continuously enrolled in two mature county-organized Medicaid managed care plans for 6, 12, and 24 months received recommended well-child visits and immunizations. We also investigated whether any improvements in compliance were evident during the period 1989-1992. Compliance was low for well-child visits and immunizations at the recommended ages regardless of eligibility group. Although slight improvements in immunizations were made over time, little progress was made in compliance with well-child visits. Continued vigilance is required to achieve the government's goal of 90 percent immunization compliance among 2-year-olds.</p><p>authors: Freund, Deborah A; Gavin, Norma I</p><p>issue_mesh: Child : Managed Care Programs : Medicaid : California : Evaluation Studies : Human : Multivariate Analysis : Preventive Health Services/utilization : United States</p><p>issue_number: 4</p><p>ntis_number: PB2000-102913</p><p>page_range: 69-83</p><p>primary_author: Lo Sasso, Anthony T</p><p>title: Children's preventive care under two mature Medicaid managed care plans in California.</p><p>volume: 19</p><p>year_period: 1998 Summer</p>]]></description></item><item><title>Effects of supplemental coverage on use of services by Medicare enrollees [corrected and republished article originally printed in Health Care Finance Rev 1997 Fall;19(1):5-17]</title><pubDate>Mon, 04 Nov 2019 02:27:24 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191529</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191529</guid><description><![CDATA[<p>abstract: This article estimates the extent to which private insurance supplements affect use of services by Medicare enrollees. Three types of supplements to Medicare's coverage are examined--Health Maintenance Organizations (HMOs), medigap (MGP) plans, and employment-based indemnity (EBI) plans. While each kind of supplement reduces cost sharing on Medicare-covered services, only HMOs do so without increasing enrollees' overall use of services. Use of services by HMO enrollees is about 4 percent lower than use by similar Medicare enrollees with no insurance supplement. By contrast, use of services by enrollees with MGP coverage is 28 percent higher, and use of services by enrollees with EBI plans is 17 percent higher.</p><p>authors: Shinogle, Judy</p><p>issue_mesh: Insurance Coverage : Adult : Aged : Comparative Study : Female : Health Benefit Plans, Employee/statistics &#x26; numerical data/utilization : Health Care Surveys : Health Maintenance Organizations/utilization : Health Services Needs and Demand/statistics &#x26; numerical data : Human : Insurance, Medigap/utilization : Male : Medicare/statistics &#x26; numerical data/utilization : United States</p><p>issue_number: 2</p><p>ntis_number: PB99-109639</p><p>page_range: suppl 5-17</p><p>primary_author: Christensen, Sandra</p><p>title: Effects of supplemental coverage on use of services by Medicare enrollees [corrected and republished article originally printed in Health Care Finance Rev 1997 Fall;19(1):5-17]</p><p>volume: 19</p><p>year_period: 1997 Winter</p>]]></description></item><item><title>Profile of Medicare beneficiaries with AIDS: application of an AIDS casefinding algorithm.</title><pubDate>Mon, 04 Nov 2019 02:27:24 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191532</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191532</guid><description><![CDATA[<p>abstract: This profile of Medicare beneficiaries with acquired immunodeficiency syndrome (AIDS) was developed by applying a case finding algorithm to virtually all Medicare claims from 1991-93. The algorithm identified more than 37,000 beneficiaries with AIDS, approximately 21,000 of whom were living at the end of 1993. These estimates suggest that as many as 12 percent of people living with AIDS at the end of 1993 were covered by Medicare. Medicare expenditures for these beneficiaries averaged more than $2,400 per month and totaled more than $500 million in 1993. These expenditures are likely to rise as more people with AIDS live long enough to qualify for Medicare coverage.</p><p>authors: Cherlow, Ann L; Thornton, Craig V; Turner, Barbara J</p><p>issue_mesh: Algorithms : Acquired Immunodeficiency Syndrome/economics/epidemiology/mortality : Adolescence : Adult : Aged : Aged, 80 and over : Demography : Eligibility Determination : Female : Health Expenditures/statistics &#x26; numerical data/trends : Health Services Research : Health Services/utilization : Human : Insurance Claim Review : Male : Medicare/statistics &#x26; numerical data/utilization : Middle Age : Support, U.S. Gov't, Non-P.H.S. : United States/epidemiology</p><p>issue_number: 3</p><p>ntis_number: PB2000-102912</p><p>page_range: 19-38</p><p>primary_author: Fasciano, Nancy J</p><p>title: Profile of Medicare beneficiaries with AIDS: application of an AIDS casefinding algorithm.</p><p>volume: 19</p><p>year_period: 1998 Spring</p>]]></description></item><item><title>Medicare: short-stay hospital services, by leading diagnosis-related groups, 1983 and 1985.</title><pubDate>Mon, 04 Nov 2019 02:27:24 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191022</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191022</guid><description><![CDATA[<p>abstract: Assigning a code from any of the diagnosis-related groups to a short-stay hospital discharge covered by Medicare is tantamount to the Medicare payment to the hospital, subject to certain statutory adjustments. Therefore, diagnosis-related groups are the backbone of the prospective payment system implemented October 1, 1983. However, methods employed in the assignment of diagnosis-related groups have changed since the prospective payment system was introduced. The focus of this article is to note some of these changes in methods of assigning diagnosis-related groups, which may have caused some of the migrations, or shifts, from one diagnosis-related group to another during the period 1983-85.</p><p>authors: Helbing, Charles</p><p>issue_mesh: Diagnosis-Related Groups/statistics &#x26; numerical data : Fees and Charges/statistics &#x26; numerical data : Hospitalization/statistics &#x26; numerical data : Length of Stay/statistics &#x26; numerical data : Medicare Assignment : Medicare/statistics &#x26; numerical data : Prospective Payment System/statistics &#x26; numerical data : United States</p><p>issue_number: 2</p><p>ntis_number: PB89-188486</p><p>page_range: 79-107</p><p>primary_author: Latta, Viola B</p><p>title: Medicare: short-stay hospital services, by leading diagnosis-related groups, 1983 and 1985.</p><p>volume: 10</p><p>year_period: 1988 Winter</p>]]></description></item><item><title>Medicare beneficiaries' attitudes about seeking health care: 1996.</title><pubDate>Mon, 04 Nov 2019 02:27:24 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191527</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191527</guid><description><![CDATA[<p>authors: Poisal, John A</p><p>issue_mesh: Attitude to Health : Data Collection : Health Care Surveys : Medicare/utilization : Patient Acceptance of Health Care/statistics &#x26; numerical data : United States</p><p>issue_number: 2</p><p>ntis_number: PB99-109639</p><p>page_range: 155-157</p><p>primary_author: Eppig, Franklin J</p><p>title: Medicare beneficiaries' attitudes about seeking health care: 1996.</p><p>volume: 19</p><p>year_period: 1997 Winter</p>]]></description></item><item><title>Acquired immunodeficiency syndrome in California's Medicaid program, 1981-84.</title><pubDate>Mon, 04 Nov 2019 02:27:24 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191013</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191013</guid><description><![CDATA[<p>abstract: In this article, Medicaid enrollment, use, and expenditures for persons with acquired immunodeficiency syndrome in California from 1981-84 are examined. The data are from Tape-to-Tape, a person-level Medicaid enrollment and claims data base. It was found that expenditures per month of enrollment decreased as length of enrollment during the year increased. Average annual expenditures increased from 1982 to 1983 and then decreased in 1984. This decrease was most pronounced in hospital services with no indication of a substitution of ambulatory services. This decline is primarily a result of a decrease in hospital reimbursement per day as opposed to changes in use, because discharge rates decreased and length of stay increased.</p><p>authors: Keyes, Margaret A; Pine, Penelope L</p><p>issue_mesh: Acquired Immunodeficiency Syndrome/economics : California : Data Collection : Eligibility Determination : Health Expenditures/statistics &#x26; numerical data : Human : Medicaid/utilization</p><p>issue_number: 1</p><p>ntis_number: PB89-188478</p><p>page_range: 95-103</p><p>primary_author: Andrews, Roxanne M</p><p>title: Acquired immunodeficiency syndrome in California's Medicaid program, 1981-84.</p><p>volume: 10</p><p>year_period: 1988 Fall</p>]]></description></item><item><title>Why do so few HMOs offer Medicare risk plans in rural areas?</title><pubDate>Mon, 04 Nov 2019 02:27:24 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191392</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191392</guid><description><![CDATA[<p>abstract: Only 17 of the 38 health maintenance organizations (HMOs) that have Medicare risk contracts and offer coverage to commercial clients in rural counties include the rural counties in their Medicare plan service areas. Rural counties in which HMOs offer Medicare coverage have higher average adjusted average per capita costs (AAPCCs), larger populations, and more physicians per capita than rural counties excluded by risk plans. Interviewed plans cite low and erratic AAPCCs, scarcity of potential enrollees, lack of negotiating power with physicians, and adverse selection as drawbacks in rural areas. Proposed changes to the payment methodology would probably lead HMOs to increase their Medicare offerings in urban fringe areas, but not in isolated rural areas.</p><p>authors: Bergeron, Jeanette W; Brown, Randall S</p><p>issue_mesh: Capitation Fee : Actuarial Analysis : Aged : Catchment Area (Health) : Health Maintenance Organizations/economics/organization &#x26; administration/statistics &#x26; numerical data : Health Services for the Aged : Human : Medicare/organization &#x26; administration/statistics &#x26; numerical data : Program Evaluation : Risk : Rural Health Services/economics/organization &#x26; administration/statistics &#x26; numerical data : Support, U.S. Gov't, Non-P.H.S. : United States</p><p>issue_number: 1</p><p>ntis_number: PB96-139548</p><p>page_range: 85-97</p><p>primary_author: Serrato, Carl A</p><p>title: Why do so few HMOs offer Medicare risk plans in rural areas?</p><p>volume: 17</p><p>year_period: 1995 Fall</p>]]></description></item><item><title>Cost containment through risk-sharing by primary care physicians: a history of the development of United Healthcare.</title><pubDate>Mon, 04 Nov 2019 02:27:24 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191057</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191057</guid><description><![CDATA[<p>abstract: A new type of independent practice association has been organized to encourage primary care physicians in private practice to become coordinators and financial managers for their patients' medical care. Each patient chooses one internist, family or general physician, or pediatrician and must be referred by that physician for all specialized care. The primary care physician authorizes payment from his/her own account for hospital and referral care provided to patients. He or she shares any deficit or surplus remaining at the end of the year. This is a background paper detailing the history of development and specific features contained in this new concept of putting the physician in charge and "at risk" for the costs of medical care to his/her patients. The plan has been operating in northern California, Washington, and Utah and has 40,000 members and 750 participating physicians. This historical background paper is part of a large project--State Employees' Insurance Benefits Utilization Study (SEIBUS) being done by the University of Washington School of Public Health to evaluate use and costs of medical care under this innovative plan.</p><p>authors: Martin, Diane P; Richardson, William C; Riedel, Donald C</p><p>issue_mesh: Physicians, Family : California : Health Benefit Plans, Employee/trends : Insurance, Health/trends : Practice Management, Medical : Primary Health Care/economics : Private Practice/economics : Reimbursement, Incentive : Support, U.S. Gov't, P.H.S. : Utah : Washington</p><p>issue_number: 4</p><p>ntis_number: PB81-112815</p><p>page_range: 1-14</p><p>primary_author: Moore, Stephen H</p><p>title: Cost containment through risk-sharing by primary care physicians: a history of the development of United Healthcare.</p><p>volume: 1</p><p>year_period: 1980 Spring</p>]]></description></item><item><title>Politics of federal health policy, 1960-75: a perspective.</title><pubDate>Mon, 04 Nov 2019 02:27:24 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191478</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191478</guid><description><![CDATA[<p>authors: N/A</p><p>issue_mesh: Politics : Government : Health Policy/history/legislation &#x26; jurisprudence : History of Medicine, 20th Cent. : Medicare/history/legislation &#x26; jurisprudence : Program Development : United States</p><p>issue_number: 2</p><p>ntis_number: PB98-110885</p><p>page_range: 169-177</p><p>primary_author: Fullerton, William D</p><p>title: Politics of federal health policy, 1960-75: a perspective.</p><p>volume: 18</p><p>year_period: 1996 Winter</p>]]></description></item><item><title>Health care indicators. Hospital, employment, and price indicators for the health care industry: second quarter 1995.</title><pubDate>Mon, 04 Nov 2019 02:27:23 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191417</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191417</guid><description><![CDATA[<p>abstract: This regular feature of the journal includes a discussion of each of the following four topics: community hospital statistics; employment, hours, and earnings in the private health sector; health care prices; and national economic indicators. These statistics are valuable in their own right for understanding the relationship between the health care sector and the overall economy. In addition, they allow us to anticipate the direction and magnitude of health care cost changes prior to the availability of more comprehensive data.</p><p>authors: Donham, Carolyn S; Heffler, Stephen K</p><p>issue_mesh: Data Collection : Delivery of Health Care/economics/statistics &#x26; numerical data/trends/utilization : Employment/statistics &#x26; numerical data/trends : Health Expenditures/statistics &#x26; numerical data/trends : Hospitals, Community/economics/statistics &#x26; numerical data/utilization : Income : Medicare/economics/statistics &#x26; numerical data : Private Sector : Skilled Nursing Facilities/economics/statistics &#x26; numerical data/utilization : United States : United States Health Care Financing Administration</p><p>issue_number: 2</p><p>ntis_number: PB96-172663</p><p>page_range: 249-287</p><p>primary_author: Sensenig, Arthur L</p><p>title: Health care indicators. Hospital, employment, and price indicators for the health care industry: second quarter 1995.</p><p>volume: 17</p><p>year_period: 1995 Winter</p>]]></description></item><item><title>Equity of the Medicaid program to the poor versus taxpayers.</title><pubDate>Mon, 04 Nov 2019 02:27:23 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191362</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191362</guid><description><![CDATA[<p>abstract: The last 15 years have witnessed explosive growth in State Medicaid programs. This article demonstrates the equalizing impacts of greater spending and recent Federal mandates on the health care coverage of the poor. Large inequalities in generosity still remain, however. Inequalities in taxpayer burdens are also documented, and simulations of alternative Federal sharing algorithms show significant changes that would be required to achieve a more equitable distribution of the program's financial burden.</p><p>authors: Adamache, Killard W; Ammering, Carol J; Bartosch, William J; Boulis, Ann</p><p>issue_mesh: Social Justice : Aid to Families with Dependent Children : Data Collection : Eligibility Determination : Health Care Rationing/economics/standards : Health Services Needs and Demand : Income Tax/statistics &#x26; numerical data/trends : Medicaid/statistics &#x26; numerical data/standards/trends : Poverty : State Health Plans/economics : United States</p><p>issue_number: 3</p><p>ntis_number: PB96-139530</p><p>page_range: 75-104</p><p>primary_author: Cromwell, Jerry L</p><p>title: Equity of the Medicaid program to the poor versus taxpayers.</p><p>volume: 16</p><p>year_period: 1995 Spring</p>]]></description></item><item><title>Changing prescription drug sector: new expenditure methodologies.</title><pubDate>Mon, 04 Nov 2019 02:27:23 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191428</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191428</guid><description><![CDATA[<p>abstract: Estimating spending for prescription drugs has become increasingly difficult over the past 15 years as extensive changes have taken place within the retail prescription drug industry. Expenditures for prescription drugs in retail outlets grew rapidly during the 1980s and early 1990s. New retail outlets emerged and existing sites lost market share. New mechanisms for reimbursing drug purchases led to the flow of rebates between manufacturers and insurers, bypassing retailers. These and other major industry changes required the development of new estimating methodologies for tracking prescription drug expenditures within the National Health Accounts (NHA).</p><p>authors: Stiller, Jean M; Trapnell, Gordon R</p><p>issue_mesh: Drug Industry/economics : Financing, Personal/statistics &#x26; numerical data : Health Expenditures/statistics &#x26; numerical data : Health Services Research/methods : Insurance, Health, Reimbursement : Insurance, Pharmaceutical Services/statistics &#x26; numerical data : Managed Care Programs/economics : Medicaid/economics/statistics &#x26; numerical data : Prescriptions, Drug/classification/economics : United States : United States Health Care Financing Administration</p><p>issue_number: 3</p><p>ntis_number: PB99-106510</p><p>page_range: 191-204</p><p>primary_author: Genuardi, James S</p><p>title: Changing prescription drug sector: new expenditure methodologies.</p><p>volume: 17</p><p>year_period: 1996 Spring</p>]]></description></item><item><title>Health status of Medicare enrollees in HMOs and fee-for-service in 1994.</title><pubDate>Mon, 04 Nov 2019 02:27:23 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191437</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191437</guid><description><![CDATA[<p>abstract: We compared the health status of 863 health maintenance organization (HMO) enrollees with that of 4,576 non-enrollees, controlling for demographics and area of residence, using 1994 data from the Medicare Current Beneficiary Survey (MCBS). HMO respondents were less likely to report fair or poor health, functional impairment, or heart disease. Average predicted costs based on various health-status measures were substantially lower for HMO respondents than for respondents in fee-for-service (FFS) arrangements. The Medicare payment formula for HMOs does not adequately adjust for the better health and consequent lower expected costs of HMO enrollees. The addition of health-status measures would improvement payment accuracy and reduce average HMO payments significantly below current levels.</p><p>authors: Chiang, Yen P; Ingber, Melvin J; Tudor, Cynthia G</p><p>issue_mesh: Health Status Indicators : Activities of Daily Living : Aged : Capitation Fee : Comparative Study : Fee-for-Service Plans/utilization : Female : Health Care Surveys : Health Maintenance Organizations/utilization : Human : Longitudinal Studies : Male : Medicare/utilization : Rate Setting and Review : United States</p><p>issue_number: 4</p><p>ntis_number: PB97-104087</p><p>page_range: 65-76</p><p>primary_author: Riley, Gerald F</p><p>title: Health status of Medicare enrollees in HMOs and fee-for-service in 1994.</p><p>volume: 17</p><p>year_period: 1996 Summer</p>]]></description></item><item><title>Medicare beneficiaries rate their medical care: new data from the MCBS (Medicare Current Beneficiary Survey).</title><pubDate>Mon, 04 Nov 2019 02:27:23 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191381</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191381</guid><description><![CDATA[<p>abstract: The Medicare Current Beneficiary Survey (MCBS) contains a wealth of information about the people whose care is financed by the program. This article examines their satisfaction with medical care received and explores the relationship of these attitudes with the characteristics of subgroups of the enrolled population. Satisfaction with medical care among Medicare beneficiaries is found to be generally high (80-90 percent). Disabled Medicare beneficiaries are less satisfied than the aged, and health maintenance organization (HMO) enrollees less satisfied than fee-for-service (FFS) patients. Others with lower-than-average satisfaction are people with poorer health status, those covered by Medicaid, and those without supplementary insurance.</p><p>authors: N/A</p><p>issue_mesh: Aged : Data Collection : Deductibles and Coinsurance : Demography : Disabled Persons : Fee-for-Service Plans/standards : Health Maintenance Organizations/standards : Health Services Research : Health Status : Human : Medicare/standards : Patient Satisfaction/statistics &#x26; numerical data : Quality of Health Care/statistics &#x26; numerical data : United States</p><p>issue_number: 4</p><p>ntis_number: PB99-106445</p><p>page_range: 175-187</p><p>primary_author: Adler, Gerald S</p><p>title: Medicare beneficiaries rate their medical care: new data from the MCBS (Medicare Current Beneficiary Survey).</p><p>volume: 16</p><p>year_period: 1995 Summer</p>]]></description></item><item><title>Medicaid and pregnant women: who is being enrolled and when.</title><pubDate>Mon, 04 Nov 2019 02:27:23 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191403</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191403</guid><description><![CDATA[<p>abstract: Medicaid eligibility expansions and improved enrollment procedures for pregnant women during the late 1980s are examined in this article. Results show that the number of births financed by Medicaid has increased dramatically, and that women are enrolling earlier in the course of pregnancy. Nevertheless, problems continue to exist. If substantial numbers of women continue to enroll late in pregnancy, the expansions may not promote significantly earlier use of prenatal care.</p><p>authors: Kenney, Genevieve M</p><p>issue_mesh: Eligibility Determination : Pregnancy : Delivery/economics : Demography : Female : Health Services Accessibility/economics : Health Services Research : Human : Maternal Health Services/economics : Medicaid/trends/utilization : Pregnancy Trimester, First : Support, Non-U.S. Gov't : United States</p><p>issue_number: 2</p><p>ntis_number: PB96-172663</p><p>page_range: 7-28</p><p>primary_author: Ellwood, Marilyn R</p><p>title: Medicaid and pregnant women: who is being enrolled and when.</p><p>volume: 17</p><p>year_period: 1995 Winter</p>]]></description></item><item><title>Toward a 21st century quality-measurement system for managed-care organizations.</title><pubDate>Mon, 04 Nov 2019 02:27:23 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191373</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191373</guid><description><![CDATA[<p>abstract: As the Nation's largest managed-care purchaser, the Health Care Financing Administration (HCFA) is working to develop a uniform data and performance-measurement system for all enrollees in managed-care plans. This effort will ultimately hold managed-care plans accountable for continuous improvement in the quality of care they provide and will provide information to consumers and purchasers to make responsible managed-care choices. The effort entails overhauling peer review organization (PRO) conduct of health maintenance organization (HMO) quality review, pilot testing a new HMO performance-measurement system, establishing criteria for Medicaid HMO quality-assurance (QA) programs, adapting employers' HMO performance reporting systems to the needs of Medicare and Medicaid, and participation in a new alliance between public and private sector managed-care purchasers to promote quality improvement and accountability for health plans.</p><p>authors: Elstein, Paul; Gorman, John K</p><p>issue_mesh: Capitation Fee : Health Services Research : Managed Care Programs/standards : Medicaid/standards/trends : Medicare/standards/trends : Professional Review Organizations/organization &#x26; administration : Quality Assurance, Health Care/organization &#x26; administration/trends : Social Responsibility : United States : United States Health Care Financing Administration</p><p>issue_number: 4</p><p>ntis_number: PB99-106445</p><p>page_range: 25-37</p><p>primary_author: Armstead, Rodney C</p><p>title: Toward a 21st century quality-measurement system for managed-care organizations.</p><p>volume: 16</p><p>year_period: 1995 Summer</p>]]></description></item><item><title>Medicaid managed care: how do community health centers fit?</title><pubDate>Mon, 04 Nov 2019 02:27:23 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191442</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191442</guid><description><![CDATA[<p>abstract: Managed care has brought about important changes in how the health care system is financed and services delivered. The authors describe the approaches adopted by community health centers to participate in Medicaid managed care and argue that these providers, commonly referred to as providers of last resort, have a role to play in this system. Many challenges lie ahead for these centers, such as the potential imposition of Medicaid block grants, the increasing number of uninsured persons, and cuts in both Federal grants and State budgets. These various forces may adversely impact health centers, leaving them with more uninsured patients and fewer resources.</p><p>authors: Markus, Anne R</p><p>issue_mesh: Community Health Centers/organization &#x26; administration : Eligibility Determination : Managed Care Programs/organization &#x26; administration : Medicaid/organization &#x26; administration : Medically Underserved Area : Medically Uninsured : Models, Organizational : Oregon : Rhode Island : State Health Plans/organization &#x26; administration : Support, U.S. Gov't, P.H.S. : Transients and Migrants : United States</p><p>issue_number: 4</p><p>ntis_number: PB97-104087</p><p>page_range: 135-142</p><p>primary_author: Henderson, Tim</p><p>title: Medicaid managed care: how do community health centers fit?</p><p>volume: 17</p><p>year_period: 1996 Summer</p>]]></description></item><item><title>The politics of Medicare and health reform, then and now.</title><pubDate>Mon, 04 Nov 2019 02:27:23 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191477</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191477</guid><description><![CDATA[<p>authors: N/A</p><p>issue_mesh: Politics : Health Care Reform/history/legislation &#x26; jurisprudence : Health Expenditures : Health Policy/history/legislation &#x26; jurisprudence : History of Medicine, 20th Cent. : Medicare/history/legislation &#x26; jurisprudence : United States</p><p>issue_number: 2</p><p>ntis_number: PB98-110885</p><p>page_range: 163-168</p><p>primary_author: Brown, Lawrence D</p><p>title: The politics of Medicare and health reform, then and now.</p><p>volume: 18</p><p>year_period: 1996 Winter</p>]]></description></item><item><title>Monitoring and evaluating the delivery of services under managed care.</title><pubDate>Mon, 04 Nov 2019 02:27:23 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191433</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191433</guid><description><![CDATA[<p>abstract: This overview discusses the importance of monitoring and evaluating the delivery of services under managed care, particularly with respect to assessing access and quality in managed care. It also lists recent Health Care Financing Administration (HCFA) initiatives in this area, and presents an introduction to the articles published in this issue of the Review. The topics addressed by these articles range from assessing and monitoring access and quality provided by traditional types of managed care organizations (MCOs) serving Medicare and Medicaid beneficiaries to issues that must be considered in developing and monitoring new delivery system models.</p><p>authors: Wolf, Linda F</p><p>issue_mesh: Evaluation Studies : Health Services Accessibility : Health Services Research : Managed Care Programs/standards/utilization : Medicaid/organization &#x26; administration : Medicare/organization &#x26; administration : Quality of Health Care : United States : United States Health Care Financing Administration</p><p>issue_number: 4</p><p>ntis_number: PB97-104087</p><p>page_range: 1-4</p><p>primary_author: Hadley, James P</p><p>title: Monitoring and evaluating the delivery of services under managed care.</p><p>volume: 17</p><p>year_period: 1996 Summer</p>]]></description></item><item><title>Role of information in consumer selection of health plans.</title><pubDate>Mon, 04 Nov 2019 02:27:23 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191452</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191452</guid><description><![CDATA[<p>abstract: Considerable efforts are underway in the public and private sectors to increase the amount of information available to consumers when making health plan choices. The objective of this study was to examine the role of information in consumer health plan decisionmaking. A computer system was developed which provides different plan descriptions with the option of accessing varying types and levels of information. The system tracked the information search processes and recorded the hypothetical plan choices of 202 subjects. Results are reported showing the relationship between information and problem perception, preference structure, choice of plan, and attitude towards the decision.</p><p>authors: Booske, Bridget C</p><p>issue_mesh: Consumer Participation : Attitude to Health : Competitive Medical Plans/utilization : Consumer Satisfaction : Decision Making : Evaluation Studies : Health Services Research/methods : Human : Information Services/utilization : Managed Care Programs/utilization : Support, U.S. Gov't, Non-P.H.S. : United States</p><p>issue_number: 1</p><p>ntis_number: PB99-106494</p><p>page_range: 31-54</p><p>primary_author: Sainfort, Francois</p><p>title: Role of information in consumer selection of health plans.</p><p>volume: 18</p><p>year_period: 1996 Fall</p>]]></description></item><item><title>Diagnosis-based risk adjustment for Medicare capitation payments.</title><pubDate>Mon, 04 Nov 2019 02:27:23 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191423</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191423</guid><description><![CDATA[<p>abstract: Using 1991-92 data for a 5-percent Medicare sample, we develop, estimate, and evaluate risk-adjustment models that utilize diagnostic information from both inpatient and ambulatory claims to adjust payments for aged and disabled Medicare enrollees. Hierarchical coexisting conditions (HCC) models achieve greater explanatory power than diagnostic cost group (DCG) models by taking account of multiple coexisting medical conditions. Prospective models predict average costs of individuals with chronic conditions nearly as well as concurrent models. All models predict medical costs far more accurately than the current health maintenance organization (HMO) payment formula.</p><p>authors: Ash, Arlene S; Ayanian, John Z; Bates, David W; Burstin, Helen; Iezzoni, Lisa I; Pope, Gregory C</p><p>issue_mesh: Capitation Fee : Aged : Diagnosis-Related Groups/economics : Disability Evaluation : Disabled Persons/classification : Female : Health Care Costs : Health Maintenance Organizations/classification/economics : Human : Male : Medicaid/classification/economics : Medicare/classification/organization &#x26; administration : Models, Economic : Rate Setting and Review/methods : Regression Analysis : Risk Management : Support, U.S. Gov't, Non-P.H.S. : United States</p><p>issue_number: 3</p><p>ntis_number: PB99-106510</p><p>page_range: 101-128</p><p>primary_author: Ellis, Randall P</p><p>title: Diagnosis-based risk adjustment for Medicare capitation payments.</p><p>volume: 17</p><p>year_period: 1996 Spring</p>]]></description></item><item><title>Occupational adjustment of the prospective payment system wage index.</title><pubDate>Mon, 04 Nov 2019 02:27:23 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191072</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191072</guid><description><![CDATA[<p>abstract: In this article, the bias in the Medicare prospective payment system (PPS) hospital wage index that results from its failure to hold hospital occupation mix constant is examined. On average, the difference between the current PPS wage index and a fixed-occupation-mix Laspeyres index is small, approximately 2 percent. However, occupation-mix distortions are substantially larger for a small proportion of labor market areas, especially some in the South. Biases in the wage index resulting from its failure to appropriately account for labor substitution and intra-occupational worker characteristics are also analyzed but are not found to be significant.</p><p>authors: N/A</p><p>issue_mesh: Abstracting and Indexing : Catchment Area (Health)/economics : Comparative Study : Data Collection : Health Occupations/economics : Medicare/statistics &#x26; numerical data : Models, Statistical : Personnel, Hospital/economics : Prospective Payment System/statistics &#x26; numerical data : Salaries and Fringe Benefits/statistics &#x26; numerical data : United States</p><p>issue_number: 1</p><p>ntis_number: PB90-146705</p><p>page_range: 49-61</p><p>primary_author: Pope, Gregory C</p><p>title: Occupational adjustment of the prospective payment system wage index.</p><p>volume: 11</p><p>year_period: 1989 Fall</p>]]></description></item><item><title>Medicare and physician autonomy.</title><pubDate>Mon, 04 Nov 2019 02:27:23 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191473</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191473</guid><description><![CDATA[<p>authors: Lee, Philip R</p><p>issue_mesh: Professional Autonomy : Diagnosis-Related Groups/economics : Fees, Medical : History of Medicine, 20th Cent. : Medicare Part A/economics/history/legislation &#x26; jurisprudence : Medicare Part B/economics/history/legislation &#x26; jurisprudence : Physicians/economics : Professional Review Organizations : Program Evaluation : Rate Setting and Review : United States</p><p>issue_number: 2</p><p>ntis_number: PB98-110885</p><p>page_range: 115-130</p><p>primary_author: Culbertson, Richard A</p><p>title: Medicare and physician autonomy.</p><p>volume: 18</p><p>year_period: 1996 Winter</p>]]></description></item><item><title>Effect of mergers on health maintenance organization premiums.</title><pubDate>Mon, 04 Nov 2019 02:27:23 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191427</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191427</guid><description><![CDATA[<p>abstract: This study estimated the effect of mergers on health maintenance organization (HMO) premiums, using data on all operational non-Medicaid HMOs in the United States from 1985 to 1993. Two critical issues were examined: whether HMO mergers increase or decrease premiums; and whether the effects of mergers differ according to the degree of competition among HMOs in local markets. The only significant merger effect was found in the most competitive markets, where premiums increased, but only for 1 year after the merger. Our research does not support the argument that consolidation of HMOs in local markets will benefit consumers through lower premiums.</p><p>authors: Christianson, Jon B; Wholey, Gouglas</p><p>issue_mesh: Capitation Fee : Economic Competition : Evaluation Studies : Health Facility Merger/economics : Health Maintenance Organizations/economics : Health Services Research : Independent Practice Associations : Models, Economic : Regression Analysis : Support, Non-U.S. Gov't : United States</p><p>issue_number: 3</p><p>ntis_number: PB99-106510</p><p>page_range: 171-189</p><p>primary_author: Feldman, Roger</p><p>title: Effect of mergers on health maintenance organization premiums.</p><p>volume: 17</p><p>year_period: 1996 Spring</p>]]></description></item><item><title>Risk-adjusted Medicare capitation rates using ambulatory and inpatient diagnoses.</title><pubDate>Mon, 04 Nov 2019 02:27:23 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191422</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191422</guid><description><![CDATA[<p>abstract: Researchers at The Johns Hopkins University (JHU) developed two new diagnosis-oriented methodologies for setting risk adjusted capitation rates for managed care plans contracting with Medicare. These adjusters predict the future medical expenditures of aged Medicare enrollees based on demographic factors and diagnostic information. The models use the Ambulatory Care Group (ACG) algorithm to categorize ambulatory diagnoses. Two alternative approaches for categorizing inpatient diagnoses were used. Lewin-VHI, Inc. evaluated the models using data from 624,000 randomly selected aged Medicare beneficiaries. The models predict expenditures far better than the Adjusted Average per Capita Cost (AAPCC) payment method. It is possible that risk adjusted capitation payments could encourage health plans to compete on the basis of efficiency and quality and not risk selection.</p><p>authors: Anderson, Gerald F; Coleman, Kevin; Dobson, Allen; Maxwell, Stephanie L; Starfield, Barbara</p><p>issue_mesh: Capitation Fee : Aged : Aged, 80 and over : Algorithms : Ambulatory Care/economics : Disability Evaluation : Female : Health Care Costs : Hospitalization/economics : Human : Insurance Selection Bias : Male : Medicare/economics : Models, Economic : Rate Setting and Review/methods : Regression Analysis : Risk Management : Support, U.S. Gov't, Non-P.H.S. : United States : United States Health Care Financing Administration</p><p>issue_number: 3</p><p>ntis_number: PB99-106510</p><p>page_range: 77-99</p><p>primary_author: Weiner, Jonathan P</p><p>title: Risk-adjusted Medicare capitation rates using ambulatory and inpatient diagnoses.</p><p>volume: 17</p><p>year_period: 1996 Spring</p>]]></description></item><item><title>Medicare Transaction System: platform for change.</title><pubDate>Mon, 04 Nov 2019 02:27:21 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191355</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191355</guid><description><![CDATA[<p>abstract: This article provides an overview of the Medicare Transaction System (MTS), a Health Care Financing Administration (HCFA)-wide initiative to be implemented starting in 1997 which will develop a national, standard, integrated, government-owned, contractor-operated Medicare claims processing system that will meet the challenges confronting Medicare over the next 2 decades. The authors discuss MTS goals and objectives, major features, how it will work, standardization efforts being undertaken in support of the initiative, contracting efforts involved, and project status.</p><p>authors: Jackson, Karen E; Veiel, Eric L</p><p>issue_mesh: Insurance Claim Review/organization &#x26; administration : Medicare/organization &#x26; administration : Organizational Innovation : Organizational Objectives : United States : United States Health Care Financing Administration</p><p>issue_number: 2</p><p>ntis_number: PB99-106486</p><p>page_range: 191-199</p><p>primary_author: Warren, Mary E</p><p>title: Medicare Transaction System: platform for change.</p><p>volume: 16</p><p>year_period: 1994 Winter</p>]]></description></item><item><title>Participation in the Qualified Medical Beneficiary Program.</title><pubDate>Mon, 04 Nov 2019 02:27:21 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191412</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191412</guid><description><![CDATA[<p>abstract: This article has three objectives: to estimate how many eligible elderly beneficiaries are participating in the Qualified Medicare Beneficiary (QMB) program; to determine the characteristics of participating and non participating eligibles; and to identify the most significant barriers to program participation. We used data from the Medicare Current Beneficiary Survey (MCBS) and the Medicare Buy-In file. We found that 41 percent of QMB eligibles are enrolled in the program; participation is higher for poor and less educated beneficiaries, those in poorer health, rural residents, African Americans, and Hispanics. Finally, we found that, in general, eligible beneficiaries are ill informed about the program.</p><p>authors: Bayer, Ellen J; Bernardin, Mimi D; Evans, William N</p><p>issue_mesh: Eligibility Determination : Poverty : Aged : Awareness : Demography : Health Services Accessibility/economics/statistics &#x26; numerical data : Health Services Research : Health Status : Human : Medicare/statistics &#x26; numerical data/utilization : Regression Analysis : Social Class : Support, U.S. Gov't, Non-P.H.S. : United States</p><p>issue_number: 2</p><p>ntis_number: PB96-172663</p><p>page_range: 169-178</p><p>primary_author: Neumann, Peter J</p><p>title: Participation in the Qualified Medical Beneficiary Program.</p><p>volume: 17</p><p>year_period: 1995 Winter</p>]]></description></item><item><title>Medicaid and state health care reform: process, programs, and policy options.</title><pubDate>Mon, 04 Nov 2019 02:27:21 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191363</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191363</guid><description><![CDATA[<p>abstract: Health care reform is a continuously evolving process. The States and the Federal Government have struggled with policy issues to combat escalating Medicaid expenditures while ensuring access and quality of care to an ever-expanding population. In the absence of national health care reform, States are increasingly relying on Federal waivers to develop innovative approaches to address a myriad of issues associated with the present health care delivery system. This article provides a summary of State health care reform efforts that have been initiated under Federal waiver authority.</p><p>authors: Boben, Paul J; Boulmetis, Maria; Fingold, Helaine I; Hadley, James P; Rama, Kathy L; VanHoven, Debbie</p><p>issue_mesh: Evaluation Studies : Florida : Hawaii : Health Care Costs : Health Care Reform/legislation &#x26; jurisprudence : Health Expenditures/legislation &#x26; jurisprudence/trends : Health Services Accessibility/legislation &#x26; jurisprudence : Kentucky : Managed Care Programs/legislation &#x26; jurisprudence : Medicaid/legislation &#x26; jurisprudence/utilization : Oregon : Patient Satisfaction : Quality of Health Care : Rhode Island : State Health Plans/economics/legislation &#x26; jurisprudence : Tennessee : United States</p><p>issue_number: 3</p><p>ntis_number: PB96-139530</p><p>page_range: 105-120</p><p>primary_author: Rotwein, Suzanne</p><p>title: Medicaid and state health care reform: process, programs, and policy options.</p><p>volume: 16</p><p>year_period: 1995 Spring</p>]]></description></item><item><title>Medicaid disproportionate share and other special financing programs.</title><pubDate>Mon, 04 Nov 2019 02:27:21 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191360</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191360</guid><description><![CDATA[<p>abstract: Medicaid disproportionate share hospital (DSH) and related programs, such as provider-specific taxes or intergovernmental transfers (IGTs), help support uncompensated care and effectively reduce State Medicaid expenditures by increasing Federal matching funds. We analyze the uses of these funds, based on a survey completed by 39 States and case studies of 6 States. We find that only a small share of these funds were available to cover the costs of uncompensated care. One method to ensure that funds are used for health care would be to reprogram funds into health insurance subsidies. An alternative to improve equity of funding across the Nation would be to create a substitute Federal grant program to directly support uncompensated care.</p><p>authors: Coughlin, Teresa A</p><p>issue_mesh: Data Collection : Economics, Hospital/trends : Health Care Reform : Health Expenditures/statistics &#x26; numerical data/trends : Medicaid/legislation &#x26; jurisprudence/statistics &#x26; numerical data/utilization : State Health Plans/economics : Support, Non-U.S. Gov't : Taxes : Uncompensated Care/economics/statistics &#x26; numerical data : United States</p><p>issue_number: 3</p><p>ntis_number: PB96-139530</p><p>page_range: 27-54</p><p>primary_author: Ku, Leighton</p><p>title: Medicaid disproportionate share and other special financing programs.</p><p>volume: 16</p><p>year_period: 1995 Spring</p>]]></description></item><item><title>Improving the AAPCC (adjusted average per capita cost) with health-status measures from the MCBS (Medicare Current Beneficiary Survey).</title><pubDate>Mon, 04 Nov 2019 02:27:21 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191421</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191421</guid><description><![CDATA[<p>abstract: Using data from the 1991 Medicare Current Beneficiary Survey (MCBS), multiple regression-based models predicting 1992 Medicare costs are developed and compared. A comprehensive model incorporating demographic, diagnostic, perceived health, and disability variables is shown to be stable and to fit the data well over the full range of Medicare-covered annual per capita expenses and for a variety of beneficiary subgroups defined by their health and functional status. This model produces stable unbiased estimates of expenditures on validation samples. A variant of this model is being considered for use in setting Medicare capitation payments for the second phase of the social/health maintenance organization (S/HMO) demonstration.</p><p>authors: Hornbrook, Mark C; Kaganova, Eugenia</p><p>issue_mesh: Capitation Fee : Health Status Indicators : Activities of Daily Living : Aged : Chronic Disease/classification/epidemiology : Disability Evaluation : Female : Health Care Costs : Health Maintenance Organizations/economics/standards : Human : Insurance Selection Bias : Male : Medicare/organization &#x26; administration/statistics &#x26; numerical data : Models, Economic : Regression Analysis : Risk Management : Support, U.S. Gov't, Non-P.H.S. : United States</p><p>issue_number: 3</p><p>ntis_number: PB99-106510</p><p>page_range: 59-75</p><p>primary_author: Gruenberg, Leonard</p><p>title: Improving the AAPCC (adjusted average per capita cost) with health-status measures from the MCBS (Medicare Current Beneficiary Survey).</p><p>volume: 17</p><p>year_period: 1996 Spring</p>]]></description></item><item><title>Hospital department cost and employment increases: 1980-92.</title><pubDate>Mon, 04 Nov 2019 02:27:21 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191396</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191396</guid><description><![CDATA[<p>abstract: Hospital costs have continued to rise at rates well in excess of inflation generally, even after the introduction of Medicare's per case prospective payment system (PPS). This article uses a hospital subscriber microcost reporting system to show trends in costs, wages, labor hours, and outputs for more than 50 individual departments from 1980-92. Descriptive results show dramatic growth in the operating room, catheter lab, and other technologically driven cost centers. Administrative costs also increased rapidly through 1988, but slowed thereafter. The paperwork billing and collection burden of hospitals is estimated to be $6 billion in 1992, or approximately 4 percent of total expenses.</p><p>authors: Butrica, Barbara</p><p>issue_mesh: Hospital Bed Capacity/statistics &#x26; numerical data : Hospital Costs/statistics &#x26; numerical data/trends : Hospital Departments/economics/manpower/statistics &#x26; numerical data : Medicare/statistics &#x26; numerical data : Personnel Staffing and Scheduling/statistics &#x26; numerical data/trends : Personnel, Hospital/supply &#x26; distribution : Prospective Payment System/statistics &#x26; numerical data : Salaries and Fringe Benefits/statistics &#x26; numerical data : Support, U.S. Gov't, Non-P.H.S. : United States</p><p>issue_number: 1</p><p>ntis_number: PB96-139548</p><p>page_range: 147-165</p><p>primary_author: Cromwell, Jerry L</p><p>title: Hospital department cost and employment increases: 1980-92.</p><p>volume: 17</p><p>year_period: 1995 Fall</p>]]></description></item><item><title>Why Medicare matters to people who need long-term care.</title><pubDate>Mon, 04 Nov 2019 02:27:21 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191472</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191472</guid><description><![CDATA[<p>authors: Lambrew, Jeanne</p><p>issue_mesh: Health Services Needs and Demand : Insurance Benefits : Activities of Daily Living : Aged : Aged, 80 and over : Female : Health Expenditures/statistics &#x26; numerical data : Home Care Services/economics : Human : Long-Term Care/economics : Male : Medicare/statistics &#x26; numerical data/utilization : Nursing Homes/standards : Program Evaluation : United States : United States Health Care Financing Administration</p><p>issue_number: 2</p><p>ntis_number: PB98-110885</p><p>page_range: 99-112</p><p>primary_author: Feder, Judith</p><p>title: Why Medicare matters to people who need long-term care.</p><p>volume: 18</p><p>year_period: 1996 Winter</p>]]></description></item><item><title>Trends in Medicare Part B mental health utilization and expenditures: 1987-92.</title><pubDate>Mon, 04 Nov 2019 02:27:21 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191482</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191482</guid><description><![CDATA[<p>abstract: This article examines the impact of expanding Medicare Part B coverage of mental health services, based on analysis of 6 years of Medicare Part B claims data (1987-92). Inflation-adjusted per capita spending more than doubled (from $9.91 to $21.63) following the elimination of the annual outpatient treatment limit and extension of direct reimbursement to clinical psychologists and social workers. There was a 73-percent increase in the user rate (from 23.25 to 40.20 per 1,000 Medicare beneficiaries), and a 27-percent increase in the average number of services per user (from 8.9 to 11.3). Mental health spending increased from 1 percent to 2 percent of expenditures for Part B professional services. Ongoing monitoring of mental health utilization is desirable to ensure that recent access gains are not eroded with the increasing shift to managed care and implementation of gatekeeper mechanisms.</p><p>authors: Ammering, Carol J</p><p>issue_mesh: Ambulatory Care/economics : Health Expenditures/statistics &#x26; numerical data/trends : Human : Medicare Part B/statistics &#x26; numerical data/utilization : Mental Disorders/classification/therapy : Mental Health Services/economics/statistics &#x26; numerical data/trends : Reimbursement Mechanisms : Support, U.S. Gov't, P.H.S. : United States</p><p>issue_number: 3</p><p>ntis_number: PB98-110554</p><p>page_range: 19-42</p><p>primary_author: Rosenbach, Margo L</p><p>title: Trends in Medicare Part B mental health utilization and expenditures: 1987-92.</p><p>volume: 18</p><p>year_period: 1997 Spring</p>]]></description></item><item><title>Washington State Health Services Act: implementing comprehensive health care reform.</title><pubDate>Mon, 04 Nov 2019 02:27:21 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191367</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191367</guid><description><![CDATA[<p>abstract: In 1993, Washington State enacted the Health Services Act of 1993 (HSA) to guarantee universal access to health care through an employer mandate, with caps on premiums as the primary cost-control mechanism. The HSA represents the Nation's first formal experiment with managed competition. This article reports the results of a case study of the HSA's implementation. The study concludes that the Washington State initiative can be replicated in other States, but that implementation is complex, requires sustained public education, and requires cooperation from the Federal Government through program waivers. A major implementation challenge is to facilitate competition and minimize regulation.</p><p>authors: N/A</p><p>issue_mesh: Competitive Medical Plans/legislation &#x26; jurisprudence : Cost Control : Data Collection : Health Benefit Plans, Employee/legislation &#x26; jurisprudence : Health Care Costs/trends : Health Care Reform/legislation &#x26; jurisprudence/organization &#x26; administration : Health Services Accessibility/economics/trends : Health Services Needs and Demand/economics/trends : Managed Care Programs/economics/legislation &#x26; jurisprudence/organization &#x26; administration : Minority Groups : Politics : State Health Plans/economics/legislation &#x26; jurisprudence : Support, U.S. Gov't, Non-P.H.S. : United States : Washington</p><p>issue_number: 3</p><p>ntis_number: PB96-139530</p><p>page_range: 177-196</p><p>primary_author: Jacobson, Peter D</p><p>title: Washington State Health Services Act: implementing comprehensive health care reform.</p><p>volume: 16</p><p>year_period: 1995 Spring</p>]]></description></item><item><title>Health care indicators. Hospital, employment, and price indicators for the health care industry: fourth quarter 1995 and annual data for 1987-95.</title><pubDate>Mon, 04 Nov 2019 02:27:21 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191447</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191447</guid><description><![CDATA[<p>abstract: This regular feature of the journal includes a discussion of each of the following four topics: community hospital statistics; employment, hours, and earnings in the private health sector; health care prices; and national economic indicators. These statistics are valuable in their own right for understanding the relationship between the health care sector and the overall economy. In addition, they allow us to anticipate the direction and magnitude of health care cost changes prior to the availability of more comprehensive data.</p><p>authors: Donham, Carolyn S; Sensenig, Arthur L; Won, Darleen K</p><p>issue_mesh: American Hospital Association : Data Collection : Employment/statistics &#x26; numerical data/trends : Health Expenditures/statistics &#x26; numerical data/trends : Hospitals, Community/statistics &#x26; numerical data : Medicare/economics : Private Sector/economics : Rate Setting and Review : Salaries and Fringe Benefits/statistics &#x26; numerical data/trends : United States : United States Health Care Financing Administration</p><p>issue_number: 4</p><p>ntis_number: PB97-104087</p><p>page_range: 217-256</p><p>primary_author: Heffler, Stephen K</p><p>title: Health care indicators. Hospital, employment, and price indicators for the health care industry: fourth quarter 1995 and annual data for 1987-95.</p><p>volume: 17</p><p>year_period: 1996 Summer</p>]]></description></item><item><title>Access and satisfaction within the disabled Medicare population.</title><pubDate>Mon, 04 Nov 2019 02:27:21 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191411</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191411</guid><description><![CDATA[<p>abstract: Little is known about variations in the levels of access and satisfaction within the disabled Medicare population. Based on the Medicare Current Beneficiary Survey (MCBS), beneficiaries under 65 years of age were classified by original reason for disability (mental versus physical). Those with a mental disability were less likely to have a private physician as a usual source; were less satisfied with the overall quality of care, availability of after-hours care, followup care, and coordination of care; and were more likely to report unmet need, owing in large part to supply barriers. Implications for the current delivery system and for design of managed care programs are discussed.</p><p>authors: N/A</p><p>issue_mesh: Aged : Demography : Disabled Persons/classification/psychology/statistics &#x26; numerical data : Frail Elderly/psychology/statistics &#x26; numerical data : Health Services Accessibility/statistics &#x26; numerical data : Health Services Needs and Demand : Health Services Research : Human : Medicare/statistics &#x26; numerical data/standards/utilization : Mental Disorders/classification/economics : Multivariate Analysis : Patient Satisfaction/statistics &#x26; numerical data : Support, U.S. Gov't, P.H.S. : United States : United States Health Care Financing Administration</p><p>issue_number: 2</p><p>ntis_number: PB96-172663</p><p>page_range: 147-167</p><p>primary_author: Rosenbach, Margo L</p><p>title: Access and satisfaction within the disabled Medicare population.</p><p>volume: 17</p><p>year_period: 1995 Winter</p>]]></description></item><item><title>Health Care Quality Improvement Program: a new approach.</title><pubDate>Mon, 04 Nov 2019 02:27:21 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191372</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191372</guid><description><![CDATA[<p>abstract: The Health Care Financing Administration (HCFA) has embarked on a new program to ensure the quality of care provided to Medicare and Medicaid beneficiaries. The approach, entitled the Health Care Quality Improvement Program (HCQIP), focuses on improving the outcomes of care, measuring improvement, and surveying for patient satisfaction. HCQIP, still in its infancy, is undertaken in collaboration with the providers of care. This article describes HCQIP.</p><p>authors: N/A</p><p>issue_mesh: Certification : Health Education : Health Facilities/standards : Human : Kidney Failure, Chronic : Medicaid/standards : Medicare/standards : Outcome Assessment (Health Care) : Patient Satisfaction : Practice Guidelines : Professional Review Organizations : Quality Assurance, Health Care/organization &#x26; administration : United States : United States Health Care Financing Administration</p><p>issue_number: 4</p><p>ntis_number: PB99-106445</p><p>page_range: 15-23</p><p>primary_author: Gagel, Barbara J</p><p>title: Health Care Quality Improvement Program: a new approach.</p><p>volume: 16</p><p>year_period: 1995 Summer</p>]]></description></item><item><title>Health care indicators. Hospital, employment, and price indicators for the health care industry--third quarter 1995.</title><pubDate>Mon, 04 Nov 2019 02:27:21 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191432</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191432</guid><description><![CDATA[<p>abstract: This regular feature of the journal includes a discussion of each of the following four topics: community hospital statistics; employment, hours, and earnings in the private health sector; health care prices; and national economic indicators. These statistics are valuable in their own right for understanding the relationship between the health care sector and the overall economy. In addition, they allow us to anticipate the direction and magnitude of health care cost changes prior to the availability of more comprehensive data.</p><p>authors: Donham, Carolyn S; Heffler, Stephen K</p><p>issue_mesh: Adolescence : Adult : Aged : Child : Child, Preschool : Data Collection : Employment/statistics &#x26; numerical data/trends : Financing, Personal/statistics &#x26; numerical data/trends : Health Expenditures/statistics &#x26; numerical data/trends : Home Care Agencies/economics/statistics &#x26; numerical data : Hospitals, Community/economics/statistics &#x26; numerical data/trends : Human : Income/statistics &#x26; numerical data : Infant : Medicare/economics/statistics &#x26; numerical data : Middle Age : United States : United States Health Care Financing Administration</p><p>issue_number: 3</p><p>ntis_number: PB99-106510</p><p>page_range: 269-306</p><p>primary_author: Sensenig, Arthur L</p><p>title: Health care indicators. Hospital, employment, and price indicators for the health care industry--third quarter 1995.</p><p>volume: 17</p><p>year_period: 1996 Spring</p>]]></description></item><item><title>Variations in rural hospital costs: effects of market concentration and location.</title><pubDate>Mon, 04 Nov 2019 02:27:21 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191391</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191391</guid><description><![CDATA[<p>abstract: This article explores two neglected questions: (1) Does the relationship between hospital concentration and costs vary between urban and rural markets? and (2) Do hospital costs in non-metropolitan areas vary with rurality? Covariance model results using 1992 data reveal that: (1) Although metropolitan and urban markets exhibit a negative relationship between hospital average costs and market concentration, non-metropolitan and rural markets fail to exhibit any relationship between costs and concentration; and (2) among non-metropolitan hospitals, only hospitals located in single-hospital communities have lower costs than their counterparts in multiple-hospital communities, once other factors are held constant.</p><p>authors: Miller, Michael K</p><p>issue_mesh: Catchment Area (Health)/economics : Comparative Study : Geography : Hospital Costs/statistics &#x26; numerical data/standards : Hospitals, Rural/economics/statistics &#x26; numerical data : Hospitals, Urban/economics/statistics &#x26; numerical data : Models, Economic : Models, Statistical : Multivariate Analysis : Regression Analysis : United States</p><p>issue_number: 1</p><p>ntis_number: PB96-139548</p><p>page_range: 69-83</p><p>primary_author: Vogel, W Bruce</p><p>title: Variations in rural hospital costs: effects of market concentration and location.</p><p>volume: 17</p><p>year_period: 1995 Fall</p>]]></description></item><item><title>Provider specialty choice among Medicare beneficiaries treated for psychiatric disorders.</title><pubDate>Mon, 04 Nov 2019 02:27:21 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191483</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191483</guid><description><![CDATA[<p>abstract: This study estimates the probability of mental health specialist use among elderly and disabled Medicare beneficiaries treated for a primary psychiatric diagnosis, based on the 1991 Medicare Current Beneficiary Survey (MCBS) and physician claims. Beneficiaries with psychotic and affective disorders or multiple psychiatric diagnoses had a higher probability of specialty use, as did beneficiaries in counties with greater psychiatrist density. Elderly in counties with greater general practitioner density and disabled in counties with greater psychologist density were less likely to see a specialist, suggesting possible provider substitution. Government programs to recruit and retain mental health professionals in underserved areas may change provider specialty choices among Medicare beneficiaries treated for psychiatric disorders.</p><p>authors: Hermann, Richard C</p><p>issue_mesh: Aged : Ambulatory Care/utilization : Disabled Persons : Family Practice : Female : Health Care Surveys : Human : Male : Medicare Part B/statistics &#x26; numerical data/utilization : Mental Disorders/therapy : Mental Health Services/utilization : Outcome Assessment (Health Care) : Patient Acceptance of Health Care/statistics &#x26; numerical data : Psychiatry : Psychotherapy : Regression Analysis : Socioeconomic Factors : Support, U.S. Gov't, P.H.S. : United States</p><p>issue_number: 3</p><p>ntis_number: PB98-110554</p><p>page_range: 43-59</p><p>primary_author: Ettner, Susan L</p><p>title: Provider specialty choice among Medicare beneficiaries treated for psychiatric disorders.</p><p>volume: 18</p><p>year_period: 1997 Spring</p>]]></description></item><item><title>Medigap reform legislation of 1990: have the objectives been met?</title><pubDate>Mon, 04 Nov 2019 02:27:21 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191458</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191458</guid><description><![CDATA[<p>abstract: The 1990 medigap reform legislation had multiple objectives: To simplify the insurance market in order to facilitate policy comparison, provide consumer choice, provide market stability, promote competition, and avoid adverse selection. Based on case study interviews with a cross-section of individuals and organizations, we report that most of these objectives have been achieved. Consumers of medigap plans are able to make more informed choices, largely because they can adequately compare policies based on standard benefits. Marketing abuses have apparently declined, as evidenced by a decrease in the number of consumer complaints. Finally, no major detrimental impact on the insurance industry was detected. Beneficiaries still face some confusion in this market, however, such as understanding the rating methodologies used to set premiums and how this may affect their choices. Confusion could increase with the growth of managed care options.</p><p>authors: Fox, Peter D; Graham, Marcia L; Rice, Thomas</p><p>issue_mesh: Aged : Capitation Fee : Consumer Participation : Economic Competition : Evaluation Studies : Health Care Reform/legislation &#x26; jurisprudence : Health Maintenance Organizations/economics/utilization : Human : Insurance Benefits : Insurance Selection Bias : Insurance, Medigap/economics/legislation &#x26; jurisprudence/utilization : Organizational Objectives : Support, Non-U.S. Gov't : United States : United States Health Care Financing Administration</p><p>issue_number: 1</p><p>ntis_number: PB99-106494</p><p>page_range: 157-174</p><p>primary_author: McCormack, Lauren A</p><p>title: Medigap reform legislation of 1990: have the objectives been met?</p><p>volume: 18</p><p>year_period: 1996 Fall</p>]]></description></item><item><title>Potential effects of managed competition in rural areas.</title><pubDate>Mon, 04 Nov 2019 02:27:21 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191443</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191443</guid><description><![CDATA[<p>abstract: This article assesses the extent to which managed competition could be successful in rural areas. Using 1990 Medicare hospital patient origin data, over 8 million rural residents were found to live in areas potentially without provider choice. Almost all of these areas were served by providers who compete for other segments of their market. Restricting use of out-of-State providers would severely limit opportunities for choice. These findings suggest that most residents of rural States would receive cost benefits from a managed competition system if purchasing alliances are carefully defined, but consideration should be given to boundary issues when forming alliances.</p><p>authors: Howard, Hilda A; Ricketts 3d, Thomas C</p><p>issue_mesh: Catchment Area (Health)/economics : Consumer Participation : Group Purchasing : Health Care Surveys/methods : Health Services Accessibility : Hospitals, Rural/utilization : Insurance Pools : Managed Competition/utilization : Medicare/economics/utilization : Quality of Health Care : Rural Health Services/economics/standards/utilization : Support, U.S. Gov't, P.H.S. : United States</p><p>issue_number: 4</p><p>ntis_number: PB97-104087</p><p>page_range: 143-156</p><p>primary_author: Slifkin, Rebecca T</p><p>title: Potential effects of managed competition in rural areas.</p><p>volume: 17</p><p>year_period: 1996 Summer</p>]]></description></item><item><title>Racial differences in access to kidney transplantation.</title><pubDate>Mon, 04 Nov 2019 02:27:21 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191408</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191408</guid><description><![CDATA[<p>abstract: Previous work has documented large differences between black and white populations in overall kidney transplantation rates and in transplantation waiting times. This article examines access to transplantation using three measures: time from renal failure to transplant; time from renal failure to wait listing; and time from wait listing to transplantation. This study concludes the following First, no matter what measure of transplant access is used, black end stage renal disease (ESRD) beneficiaries fare worse than white, Asian-American, or Native American ESRD beneficiaries. Second, because the rate of renal failure exceeds the number of cadaver organs, access to kidney transplantation will deteriorate in future years for all races.</p><p>authors: N/A</p><p>issue_mesh: Waiting Lists : Adolescence : Adult : Asian Americans/statistics &#x26; numerical data : Blacks/statistics &#x26; numerical data : Comparative Study : Female : Health Services Accessibility/economics/statistics &#x26; numerical data : Health Services Research : Human : Indians, North American/statistics &#x26; numerical data : Kidney Failure, Chronic/surgery : Kidney Transplantation/economics/utilization : Male : Medicare/utilization : Middle Age : Multivariate Analysis : Organ Procurement/statistics &#x26; numerical data : United States/epidemiology : Whites/statistics &#x26; numerical data</p><p>issue_number: 2</p><p>ntis_number: PB96-172663</p><p>page_range: 89-103</p><p>primary_author: Eggers, Paul W</p><p>title: Racial differences in access to kidney transplantation.</p><p>volume: 17</p><p>year_period: 1995 Winter</p>]]></description></item><item><title>The drug abuse treatment gap: recent estimates.</title><pubDate>Mon, 04 Nov 2019 02:27:21 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191481</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191481</guid><description><![CDATA[<p>abstract: There is a widely acknowledged problem of drug abuse in the United States, but there is no widely accepted estimate of the number who need treatment for drug abuse. In this article, the authors present new estimates of the numbers of persons in this country who need and receive treatment. These estimates are derived from improved definitions and statistical estimating methods applied to the national Household Survey on Drug Abuse (NHSDS). There are two separate estimates (based on severity) of people needing treatment, yielding a combined total of 7.1 million people. These new estimates are crucial to better resource planning and allocation.</p><p>authors: Epstein, Joan; Gfroerer, Joseph; Melnick, Daniel; Thoreson, Richard; Willson, Douglas</p><p>issue_mesh: Data Collection : Female : Health Care Surveys : Health Services Needs and Demand/statistics &#x26; numerical data : Human : Male : Mental Health Services/statistics &#x26; numerical data/trends/utilization : Poverty : Prevalence : Sex Factors : Substance-Related Disorders/epidemiology/rehabilitation : United States/epidemiology</p><p>issue_number: 3</p><p>ntis_number: PB98-110554</p><p>page_range: 5-17</p><p>primary_author: Woodward, Albert</p><p>title: The drug abuse treatment gap: recent estimates.</p><p>volume: 18</p><p>year_period: 1997 Spring</p>]]></description></item><item><title>Medicare, Medicaid and people with disability.</title><pubDate>Mon, 04 Nov 2019 02:27:21 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191471</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191471</guid><description><![CDATA[<p>authors: Taniguchi, Carol</p><p>issue_mesh: Disabled Persons : Eligibility Determination : Health Care Reform : Health Expenditures/statistics &#x26; numerical data : Health Services Accessibility/economics : Human : Insurance Coverage/legislation &#x26; jurisprudence : Medicaid/legislation &#x26; jurisprudence/statistics &#x26; numerical data/utilization : Medicare/legislation &#x26; jurisprudence/statistics &#x26; numerical data/utilization : Program Evaluation : United States</p><p>issue_number: 2</p><p>ntis_number: PB98-110885</p><p>page_range: 91-97</p><p>primary_author: Master, Robert J</p><p>title: Medicare, Medicaid and people with disability.</p><p>volume: 18</p><p>year_period: 1996 Winter</p>]]></description></item><item><title>New directions and developments in managed care financing</title><pubDate>Mon, 04 Nov 2019 02:27:20 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191418</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191418</guid><description><![CDATA[<p>issue_number: 3</p><p>ntis_number: PB99-106510</p><p>page_range: 1-5</p><p>primary_author: Wolf, Linda F</p><p>title: New directions and developments in managed care financing</p><p>volume: 17</p><p>year_period: 1996 Spring</p>]]></description></item><item><title>Rate regulation as a policy tool: lessons from New York State.</title><pubDate>Mon, 04 Nov 2019 02:27:20 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191366</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191366</guid><description><![CDATA[<p>abstract: For over a decade, New York State has used hospital rate regulation (the New York Prospective Hospital Reimbursement Methodology [NYPHRM]) as a policy tool to achieve three objectives: containing costs, supporting financially stressed hospitals, and financing access to care for the uninsured. This case study of NYPHRM suggests that the regulatory approach, if pursued with vigor, can achieve any one of these goals. On the other hand, the New York experience also shows that these are competing goals, and that achieving all of them over a period of time can prove to be difficult.</p><p>authors: N/A</p><p>issue_mesh: Ambulatory Care/trends/utilization : Blue Cross/legislation &#x26; jurisprudence : Cost Control : Financial Management, Hospital/legislation &#x26; jurisprudence : Health Priorities : Health Services Accessibility : Health Services Needs and Demand : Medicaid/legislation &#x26; jurisprudence : New York : Program Evaluation : Prospective Payment System/legislation &#x26; jurisprudence : Quality of Health Care/economics : Rate Setting and Review/legislation &#x26; jurisprudence : State Health Plans/economics/legislation &#x26; jurisprudence : Support, U.S. Gov't, Non-P.H.S. : United States</p><p>issue_number: 3</p><p>ntis_number: PB96-139530</p><p>page_range: 151-175</p><p>primary_author: Fraser, Irene</p><p>title: Rate regulation as a policy tool: lessons from New York State.</p><p>volume: 16</p><p>year_period: 1995 Spring</p>]]></description></item><item><title>Comprehension of quality care indicators: differences among privately insured, publicly insured, and uninsured.</title><pubDate>Mon, 04 Nov 2019 02:27:20 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191453</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191453</guid><description><![CDATA[<p>abstract: This study explores consumers' comprehension of quality indicators appearing in health care report cards. Content analyses of focus group transcripts show differences in understanding individual quality indicators and among three populations: privately insured; Medicaid; and uninsured. Several rounds of coding and analysis assess: the degree of comprehension; what important ideas are not understood; and what exactly is not understood about the indicator (inter-rater reliability exceeded 94 percent). Thus, this study is an educational diagnosis of the comprehension of currently disseminated quality indicators. Fifteen focus groups (5 per insurance type) were conducted with a total of 104 participants. Findings show that consumers with differing access to and experiences with care have different levels of comprehension. Indicators are not well understood and are interpreted in unintended ways. Implications and strategies for communicating and disseminating quality information are discussed.</p><p>authors: Hibbard, Judith H</p><p>issue_mesh: Consumer Participation : Awareness : Communication : Consumer Satisfaction : Focus Groups : Health Care Surveys : Human : Information Services/standards/utilization : Insurance, Health/standards : Medicaid/standards : Medically Uninsured : Quality of Health Care/classification/standards : Support, U.S. Gov't, P.H.S. : United States</p><p>issue_number: 1</p><p>ntis_number: PB99-106494</p><p>page_range: 75-94</p><p>primary_author: Jewett, Jacquelyn J</p><p>title: Comprehension of quality care indicators: differences among privately insured, publicly insured, and uninsured.</p><p>volume: 18</p><p>year_period: 1996 Fall</p>]]></description></item><item><title>Beneficiary profile: yesterday, today, and tomorrow.</title><pubDate>Mon, 04 Nov 2019 02:27:20 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191467</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191467</guid><description><![CDATA[<p>authors: N/A</p><p>issue_mesh: Demography : Health Status : Aged : Birth Rate/trends : Chronic Disease/epidemiology : Emigration and Immigration/trends : Employment/trends : Female : Health Expenditures : Health Services/utilization : Human : Income/trends : Life Expectancy/trends : Male : Medicaid/statistics &#x26; numerical data/utilization : Medicare/statistics &#x26; numerical data/utilization : Middle Age : Morbidity/trends : Mortality/trends : Retirement/trends : Socioeconomic Factors : United States/epidemiology</p><p>issue_number: 2</p><p>ntis_number: PB98-110885</p><p>page_range: 23-46</p><p>primary_author: Rice, Dorothy P</p><p>title: Beneficiary profile: yesterday, today, and tomorrow.</p><p>volume: 18</p><p>year_period: 1996 Winter</p>]]></description></item><item><title>Use of utilization management methods in State Medicaid programs.</title><pubDate>Mon, 04 Nov 2019 02:27:20 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191438</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191438</guid><description><![CDATA[<p>abstract: This article describes the use of utilization management (UM) methods by State Medicaid programs. The use of optional UM methods range from zero in one State to eight in four States, with a median of five. A majority of States have programs for ambulatory surgery, preadmission certification, lock-in, primary-care case management, and targeted case management. Overall, no UM method was judged by States to have an adverse effect on access of quality of care. For UM methods mandated by the Medicaid program, more than one-third of the States rated physician certification as minimally effective.</p><p>authors: Silverman, Herbert A</p><p>issue_mesh: Ambulatory Surgical Procedures : Case Management : Certification : Health Care Surveys : Health Services Accessibility : Managed Care Programs/organization &#x26; administration/standards/utilization : Medicaid/organization &#x26; administration/statistics &#x26; numerical data/utilization : Physicians/standards : Quality of Health Care : State Health Plans/statistics &#x26; numerical data/utilization : United States : Utilization Review/methods/statistics &#x26; numerical data</p><p>issue_number: 4</p><p>ntis_number: PB97-104087</p><p>page_range: 77-86</p><p>primary_author: Buck, Jeffrey A</p><p>title: Use of utilization management methods in State Medicaid programs.</p><p>volume: 17</p><p>year_period: 1996 Summer</p>]]></description></item><item><title>Reconciling practice and theory: challenges in monitoring Medicaid managed-care quality.</title><pubDate>Mon, 04 Nov 2019 02:27:20 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191376</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191376</guid><description><![CDATA[<p>abstract: The massive shift to managed care in many State Medicaid programs heightens the importance of identifying effective approaches to promote and oversee quality in plans serving Medicaid enrollees. This article reviews operational issues and lessons from the ongoing evaluation of a three-State demonstration of the Health Care Financing Administration's (HCFA) Quality Assurance Reform Initiative (QARI) for Medicaid managed care. The QARI experience to date shows the potential utility of the system while drawing attention to the challenges involved in translating theory to practice. These challenges include data limitations and staffing constraints, diverse levels of sophistication among States and health plans, and the practical limitations of using quality indicators for a population that is often enrolled only on a discontinuous basis. To overcome these challenges, we suggest using realistically long timeframes for system implementation, with intermediate short-term strategies that could treat States and managed-care plans differently depending on their stage of development.</p><p>authors: Felt, Suzanne</p><p>issue_mesh: Guidelines : Health Services Research/methods : Managed Care Programs/statistics &#x26; numerical data/standards : Medicaid/statistics &#x26; numerical data/standards : Pilot Projects : Program Evaluation : Quality Assurance, Health Care/organization &#x26; administration : State Health Plans/organization &#x26; administration/standards : Support, Non-U.S. Gov't : United States : United States Health Care Financing Administration</p><p>issue_number: 4</p><p>ntis_number: PB99-106445</p><p>page_range: 85-105</p><p>primary_author: Gold, Marsha</p><p>title: Reconciling practice and theory: challenges in monitoring Medicaid managed-care quality.</p><p>volume: 16</p><p>year_period: 1995 Summer</p>]]></description></item><item><title>Black-white treatment differences in acute myocardial infarction.</title><pubDate>Mon, 04 Nov 2019 02:27:20 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191406</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191406</guid><description><![CDATA[<p>abstract: Previous research has documented that black patients with acute myocardial infarction (AMI) are significantly less likely than white patients to receive cardiac procedures. This article seeks to expand this research by: controlling for the limited ability of low income elderly to pay for care; and adjusting for the impact of differential mortality. We selected a sample of 18,202 Medicare beneficiaries admitted during 1992 with AMI, and followed them for 90 days. Even after adjusting for other factors, black patients with AMI were less likely to undergo cardiac catheterization, and if catheterized, less likely to receive a revascularization procedure.</p><p>authors: Khandker, Rezaul K</p><p>issue_mesh: Age Factors : Aged : Blacks/statistics &#x26; numerical data : Comparative Study : Health Services Accessibility/economics/statistics &#x26; numerical data : Health Services Research : Human : Medicare/standards/utilization : Multivariate Analysis : Myocardial Infarction/economics/mortality/therapy : Physician's Practice Patterns/statistics &#x26; numerical data : Socioeconomic Factors : Support, U.S. Gov't, Non-P.H.S. : United States/epidemiology : Whites/statistics &#x26; numerical data</p><p>issue_number: 2</p><p>ntis_number: PB96-172663</p><p>page_range: 61-70</p><p>primary_author: Mitchell, Janet B</p><p>title: Black-white treatment differences in acute myocardial infarction.</p><p>volume: 17</p><p>year_period: 1995 Winter</p>]]></description></item><item><title>Variations and trends in state nursing facility capacity: 1978-93.</title><pubDate>Mon, 04 Nov 2019 02:27:20 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191398</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191398</guid><description><![CDATA[<p>abstract: The demand for nursing facility (NF) beds has been growing with the aging of the population and many other factors. As the need for nursing home care grows, the Nation's capacity to provide such care is the subject of increasing concern. This article examines licensed NFs and beds, presenting data on trends from 1978-93. Measures of the adequacy of NF beds in States are examined over time, including the ratio of beds per aged population, occupancy rates, and State official's opinions of the adequacy of supply. State and regional variations are shown over time, and we speculate on the factors which may be associated with the variation.</p><p>authors: Bedney, Barbara; Carrillo, Helen; Harrington, Charlene</p><p>issue_mesh: Aged : Aged, 80 and over : Bed Occupancy/statistics &#x26; numerical data : Health Facility Size/supply &#x26; distribution/statistics &#x26; numerical data : Health Services Needs and Demand/economics/statistics &#x26; numerical data/trends : Human : Medicaid/economics : Medicare/economics : Nursing Homes/supply &#x26; distribution/statistics &#x26; numerical data/trends/utilization : State Health Plans : Support, U.S. Gov't, Non-P.H.S. : United States</p><p>issue_number: 1</p><p>ntis_number: PB96-139548</p><p>page_range: 183-199</p><p>primary_author: DuNah Jr, Richard</p><p>title: Variations and trends in state nursing facility capacity: 1978-93.</p><p>volume: 17</p><p>year_period: 1995 Fall</p>]]></description></item><item><title>Ownership and average premiums for Medicare supplementary insurance policies.</title><pubDate>Mon, 04 Nov 2019 02:27:20 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191400</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191400</guid><description><![CDATA[<p>abstract: This article describes private supplementary health insurance holdings and average premiums paid by Medicare enrollees. Data were collected as part of the 1992 Medicare Current Beneficiary Survey (MCBS). Data show the number of persons with insurance and average premiums paid by type of insurance held--individually purchased policies, employer-sponsored policies, or both. Distributions are shown for a variety of demographic, socioeconomic, and health status variables. Primary findings include: Seventy-eight percent of Medicare beneficiaries have private supplementary insurance; 25 percent of those with private insurance hold more than one policy. The average premium paid for private insurance in 1992 was $914.</p><p>authors: Eppig, Franklin J; Poisal, John A</p><p>issue_mesh: Adolescence : Adult : Aged : Aged, 80 and over : Child : Child, Preschool : Fees and Charges/statistics &#x26; numerical data : Female : Health Benefit Plans, Employee/economics/statistics &#x26; numerical data : Health Status : Human : Infant : Infant, Newborn : Insurance, Health/economics/statistics &#x26; numerical data : Male : Medicare Part B/economics/statistics &#x26; numerical data : Middle Age : Private Sector : Socioeconomic Factors : United States</p><p>issue_number: 1</p><p>ntis_number: PB96-139548</p><p>page_range: 255-275</p><p>primary_author: Chulis, George S</p><p>title: Ownership and average premiums for Medicare supplementary insurance policies.</p><p>volume: 17</p><p>year_period: 1995 Fall</p>]]></description></item><item><title>Medicare FFS populations versus HMO populations: 1993.</title><pubDate>Mon, 04 Nov 2019 02:27:20 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191431</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191431</guid><description><![CDATA[<p>authors: Poisal, John A</p><p>issue_mesh: Age Factors : Aged : Comparative Study : Data Collection : Disability Evaluation : Fee-for-Service Plans/economics/statistics &#x26; numerical data : Female : Health Maintenance Organizations/economics/statistics &#x26; numerical data : Health Status : Human : Income/statistics &#x26; numerical data : Male : Medicare/economics/statistics &#x26; numerical data : United States</p><p>issue_number: 3</p><p>ntis_number: PB99-106510</p><p>page_range: 263-267</p><p>primary_author: Eppig, Franklin J</p><p>title: Medicare FFS populations versus HMO populations: 1993.</p><p>volume: 17</p><p>year_period: 1996 Spring</p>]]></description></item><item><title>Medicare managed care: numbers and trends.</title><pubDate>Mon, 04 Nov 2019 02:27:20 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191430</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191430</guid><description><![CDATA[<p>abstract: This article captures some key trends in Medicare managed care. The figures which accompany this article explore, among other issues: enrollment; numbers of participating plans; demographic characteristics such as geographic location, age, and income; and premium and benefit comparisons.</p><p>authors: Hicks, Jarret; Taylor, Charles</p><p>issue_mesh: Age Factors : Capitation Fee/statistics &#x26; numerical data : Data Collection : Demography : Fee-for-Service Plans/economics : Health Maintenance Organizations/economics/statistics &#x26; numerical data/trends/utilization : Health Status : Human : Income : Insurance Benefits/economics/statistics &#x26; numerical data/trends : Medicare/organization &#x26; administration/statistics &#x26; numerical data/trends/utilization : Risk Management : Time Factors : United States</p><p>issue_number: 3</p><p>ntis_number: PB99-106510</p><p>page_range: 243-261</p><p>primary_author: Zarabozo, Carlos</p><p>title: Medicare managed care: numbers and trends.</p><p>volume: 17</p><p>year_period: 1996 Spring</p>]]></description></item><item><title>Hospital, employment, and price indicators for the health care industry: first quarter 1996.</title><pubDate>Mon, 04 Nov 2019 02:27:20 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191462</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191462</guid><description><![CDATA[<p>abstract: This regular feature of the journal includes a discussion of each of the following four topics: community hospital statistics; employment, hours, and earnings in the private health sector; health care prices; and national economic indicators. These statistics are valuable in their own right for understanding the relationship between the health care sector and the overall economy. In addition, they allow us to anticipate the direction and magnitude of health care cost changes prior to the availability of more comprehensive data.</p><p>authors: Heffler, Stephen K</p><p>issue_mesh: Aged : American Hospital Association : Employment/statistics &#x26; numerical data/trends : Fees, Medical/trends : Health Expenditures/statistics &#x26; numerical data/trends : Hospitalization/economics/statistics &#x26; numerical data : Hospitals, Community/economics/statistics &#x26; numerical data/utilization : Human : Income/statistics &#x26; numerical data : Inflation, Economic/statistics &#x26; numerical data : Medicare/economics/statistics &#x26; numerical data : Private Sector/economics/statistics &#x26; numerical data : United States</p><p>issue_number: 1</p><p>ntis_number: PB99-106494</p><p>page_range: 253-269</p><p>primary_author: Sensenig, Arthur L</p><p>title: Hospital, employment, and price indicators for the health care industry: first quarter 1996.</p><p>volume: 18</p><p>year_period: 1996 Fall</p>]]></description></item><item><title>HCFA's consumer information commitment.</title><pubDate>Mon, 04 Nov 2019 02:27:20 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191450</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191450</guid><description><![CDATA[<p>abstract: This article provides examples of how the Health Care Financing Administration is providing Medicare and Medicaid beneficiaries with information that will allow them to become more active participants in decisions affecting their health and well-being. The article emphasizes how HCFA has incorporated a beneficiary-centered focus and social marketing techniques in its consumer information activities. The work described in this article represents a cross section of the innovative and excellent work being done by staff throughout the Agency and by our partners and agents in meeting the information needs of beneficiaries.</p><p>authors: N/A</p><p>issue_mesh: Consumer Participation : Consumer Satisfaction : Decision Making : Information Services/organization &#x26; administration/supply &#x26; distribution : Insurance Benefits : Medicaid/organization &#x26; administration/standards/utilization : Medicare/organization &#x26; administration/standards/utilization : Online Systems : Organizational Innovation : Telephone : United States : United States Health Care Financing Administration/organization &#x26; administration</p><p>issue_number: 1</p><p>ntis_number: PB99-106494</p><p>page_range: 9-14</p><p>primary_author: McMullan, Michael</p><p>title: HCFA's consumer information commitment.</p><p>volume: 18</p><p>year_period: 1996 Fall</p>]]></description></item><item><title>Should insurers pay the same fees under an all-payer system?</title><pubDate>Mon, 04 Nov 2019 02:27:20 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191354</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191354</guid><description><![CDATA[<p>abstract: Medicare's use of diagnosis-related groups (DRGs) and the resource-based relative value scale (RBRVS) has led to interest in developing a national all-payer system in which insurers use the same payment methods and payment rates. Using data for 81 high-volume DRGs from 457 California hospitals, we conclude that a single set of rates for hospital care would not be appropriate. On average, Medicare patients were 11.7 percent more expensive than commercially insured patients, but less expensive in many DRGs. Further research is needed to determine if Medicare patients require more physician resources compared with non-Medicare patients, particularly for surgical procedures.</p><p>authors: Rice, Thomas</p><p>issue_mesh: Prospective Payment System : Relative Value Scales : California : Health Services Accessibility : Health Services Research/methods : Insurance, Hospitalization/statistics &#x26; numerical data/standards : Insurance, Physician Services/statistics &#x26; numerical data/standards : Organizational Objectives : Private Sector : Public Sector : Rate Setting and Review/standards : Regression Analysis : Support, U.S. Gov't, P.H.S.</p><p>issue_number: 2</p><p>ntis_number: PB99-106486</p><p>page_range: 175-189</p><p>primary_author: Kominski, Gerald F</p><p>title: Should insurers pay the same fees under an all-payer system?</p><p>volume: 16</p><p>year_period: 1994 Winter</p>]]></description></item><item><title>Rural hospital networks: implications for rural health reform.</title><pubDate>Mon, 04 Nov 2019 02:27:20 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191390</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191390</guid><description><![CDATA[<p>abstract: This article summarizes the perspectives gained in the course of evaluating a 4-year demonstration program that supported rural hospital networks as mechanisms for improving rural health care delivery. Findings include: (1) joining a network is a popular, low-cost strategic response for rural hospitals in an uncertain environment; (2) rural hospital network survival is enhanced by the mutual resource dependence of members and the presence of a formalized management structure; (3) rural hospitals join networks primarily to improve cost efficiency but, on average, hospitals do not appear to realize short-term economic benefit from network membership; and (4) some of the benefits of these networks may be realized outside of the communities in which rural hospitals are located.</p><p>authors: Christianson, Jon B; Johnson, Judy; Kralewski, John E; Manning Jr, Willard G</p><p>issue_mesh: Community Networks/economics/organization &#x26; administration/statistics &#x26; numerical data : Cost-Benefit Analysis : Health Care Reform/trends : Hospital Shared Services/economics/organization &#x26; administration/statistics &#x26; numerical data : Hospitals, Rural/economics/organization &#x26; administration/statistics &#x26; numerical data : Program Evaluation : Regression Analysis : Rural Health Services : Support, Non-U.S. Gov't : United States</p><p>issue_number: 1</p><p>ntis_number: PB96-139548</p><p>page_range: 53-67</p><p>primary_author: Moscovice, Ira S</p><p>title: Rural hospital networks: implications for rural health reform.</p><p>volume: 17</p><p>year_period: 1995 Fall</p>]]></description></item><item><title>Health care indicators.</title><pubDate>Mon, 04 Nov 2019 02:27:20 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191401</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191401</guid><description><![CDATA[<p>abstract: This regular feature of the journal includes a discussion of each of the following four topics: community hospital statistics; employment, hours, and earnings in the private health sector; health care prices; and national economic indicators. These statistics are valuable in their own right for understanding the relationship between the health care sector and the overall economy. In addition, they allow us to anticipate the direction and magnitude of health care cost changes prior to the availability of more comprehensive data.</p><p>authors: Donham, Carolyn S; Heffler, Stephen K</p><p>issue_mesh: Commerce/statistics &#x26; numerical data/trends : Economics : Employment/economics/statistics &#x26; numerical data : Forecasting : Health Care Costs/statistics &#x26; numerical data : Hospitals, Community/economics/statistics &#x26; numerical data : Private Sector/economics/standards : United States</p><p>issue_number: 1</p><p>ntis_number: PB96-139548</p><p>page_range: 277-317</p><p>primary_author: Sensenig, Arthur L</p><p>title: Health care indicators.</p><p>volume: 17</p><p>year_period: 1995 Fall</p>]]></description></item><item><title>Issues in measuring and improving health care quality.</title><pubDate>Mon, 04 Nov 2019 02:27:20 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191371</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191371</guid><description><![CDATA[<p>abstract: This issue of the Health Care Financing Review focuses on issues and advances in measuring and improving the quality of care, particularly for Medicare and Medicaid beneficiaries. Discussions of quality-related topics are especially timely, given the growing and widespread interest in improving quality in the organization, financing, and delivery of health care services. This article has several purposes. The first is to provide a brief description of some of the causes underlying the growth of the health care quality movement; the second is to provide a contextual framework for discussion of some of the overarching themes that emerge in this issue. These themes include examining conceptual issues, developing quality measures for specific sites and populations, and creating or adapting data sets for quality-measurement purposes.</p><p>authors: N/A</p><p>issue_mesh: Acquired Immunodeficiency Syndrome/nursing : Databases, Factual : Health Care Costs/trends : Health Services Research/methods : Hemodialysis Units, Hospital/standards : Home Care Services/organization &#x26; administration/standards : Human : Managed Care Programs/organization &#x26; administration/standards : Medicaid/standards : Medicare/standards : Nursing Homes/organization &#x26; administration/standards : Outcome and Process Assessment (Health Care) : Patient Satisfaction : Quality of Health Care/standards : United States</p><p>issue_number: 4</p><p>ntis_number: PB99-106445</p><p>page_range: 1-13</p><p>primary_author: Friedman, Maria A</p><p>title: Issues in measuring and improving health care quality.</p><p>volume: 16</p><p>year_period: 1995 Summer</p>]]></description></item><item><title>Equity in the Medicaid program: changes in the latter 1980s.</title><pubDate>Mon, 04 Nov 2019 02:27:20 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191361</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191361</guid><description><![CDATA[<p>abstract: The possibility of health care reform has helped focus attention on equity in the receipt of health care. This is a particular issue for the Medicaid program, as State variations in eligibility and payment policies have historically created inequity. This study examines equity for Medicaid beneficiaries and State taxpayers during the latter 1980s. Findings indicate that federally mandated expansions significantly increased equity in the coverage of the poor, but inequality in real resources per enrollee remained significant. Although equity improved from 1984 through 1991, the increased use of provider-specific tax and voluntary donation (T&#x26;D) programs by traditionally high-spending States played an important role in the 1992 figures.</p><p>authors: N/A</p><p>issue_mesh: Social Justice : Eligibility Determination : Health Care Rationing/economics/standards : Health Expenditures/statistics &#x26; numerical data/trends : Health Services Needs and Demand : Medicaid/statistics &#x26; numerical data/standards/trends : Poverty : State Health Plans/economics : Support, U.S. Gov't, Non-P.H.S. : Taxes : United States</p><p>issue_number: 3</p><p>ntis_number: PB96-139530</p><p>page_range: 55-73</p><p>primary_author: Adams, E Kathleen</p><p>title: Equity in the Medicaid program: changes in the latter 1980s.</p><p>volume: 16</p><p>year_period: 1995 Spring</p>]]></description></item><item><title>Health care in the early 1960s.</title><pubDate>Mon, 04 Nov 2019 02:27:20 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191466</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191466</guid><description><![CDATA[<p>authors: N/A</p><p>issue_mesh: Delivery of Health Care/history/trends : Health Benefit Plans, Employee/history/trends : History of Medicine, 20th Cent. : Insurance Coverage/history/trends : Medicaid/history/trends : Medicare/history/trends : Program Evaluation : Social Change : United States</p><p>issue_number: 2</p><p>ntis_number: PB98-110885</p><p>page_range: 11-22</p><p>primary_author: Stevens, Rosemary A</p><p>title: Health care in the early 1960s.</p><p>volume: 18</p><p>year_period: 1996 Winter</p>]]></description></item><item><title>Surveying consumer satisfaction to assess managed-care quality: current practices.</title><pubDate>Mon, 04 Nov 2019 02:27:19 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191380</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191380</guid><description><![CDATA[<p>abstract: Growing interest in using consumer satisfaction information to enhance quality of care and promote informed consumer choice has accompanied recent expansions in managed care. This article synthesizes information about consumer satisfaction surveys conducted by managed-care plans, government and other agencies, community groups, and purchasers of care. We discuss survey content, methods, and use of consumer survey information. Differences in the use of consumer surveys preclude one instrument or methodology from meeting all needs. The effectiveness of plan-based surveys could be enhanced by increased information on alternative survey instruments and methods and new methodological studies, such as ones developing risk-adjustment methods.</p><p>authors: Wooldridge, Judith</p><p>issue_mesh: Cultural Characteristics : Data Collection : Ethnic Groups : Health Services Research/methods : Managed Care Programs/organization &#x26; administration/standards : Medicaid/organization &#x26; administration/standards : Medicare/organization &#x26; administration/standards : Patient Satisfaction/statistics &#x26; numerical data : Pilot Projects : Quality of Health Care/standards : Social Responsibility : Support, U.S. Gov't, P.H.S. : United States</p><p>issue_number: 4</p><p>ntis_number: PB99-106445</p><p>page_range: 155-173</p><p>primary_author: Gold, Marsha</p><p>title: Surveying consumer satisfaction to assess managed-care quality: current practices.</p><p>volume: 16</p><p>year_period: 1995 Summer</p>]]></description></item><item><title>Medicare influence on private insurance: good or ill?</title><pubDate>Mon, 04 Nov 2019 02:27:19 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191476</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191476</guid><description><![CDATA[<p>authors: N/A</p><p>issue_mesh: Competitive Bidding : Cost Control : Credentialing : Economic Competition : Fee-for-Service Plans/economics : Insurance Coverage : Insurance, Health/economics : Insurance, Medigap/economics : Medicare/economics/organization &#x26; administration/trends : Organizational Culture : Patient Advocacy : Patient Participation : Program Evaluation : Reimbursement Mechanisms/trends : Relative Value Scales : United States</p><p>issue_number: 2</p><p>ntis_number: PB98-110885</p><p>page_range: 153-161</p><p>primary_author: Jones, Stanley B</p><p>title: Medicare influence on private insurance: good or ill?</p><p>volume: 18</p><p>year_period: 1996 Winter</p>]]></description></item><item><title>State policies and the financing of acquired immunodeficiency syndrome care.</title><pubDate>Mon, 04 Nov 2019 02:27:19 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191075</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191075</guid><description><![CDATA[<p>abstract: State policies, with respect to the operation of Medicaid programs and the regulation of private health insurance, affect who gets what care, how much is spent, and who ultimately pays. A RAND Corporation study was used to assess States and the District of Columbia in terms of the effects of their Medicaid and health insurance regulations on people with acquired immunodeficiency syndrome and other human immunodeficiency virus-related illnesses. State characteristics are used to explain the individual State policy rankings.</p><p>authors: Bennett, Charles; Cvitanic, Marilyn; Gorman, Michael; Serrato, Carl A</p><p>issue_mesh: State Health Plans : Acquired Immunodeficiency Syndrome/economics/epidemiology : Data Collection : Eligibility Determination/legislation &#x26; jurisprudence : Human : Insurance, Health/legislation &#x26; jurisprudence : Medicaid/legislation &#x26; jurisprudence : Statistics : United States</p><p>issue_number: 1</p><p>ntis_number: PB90-146705</p><p>page_range: 91-104</p><p>primary_author: Pascal, Anthony H</p><p>title: State policies and the financing of acquired immunodeficiency syndrome care.</p><p>volume: 11</p><p>year_period: 1989 Fall</p>]]></description></item><item><title>Medicare beneficiary counseling programs: what are they and do they work?</title><pubDate>Mon, 04 Nov 2019 02:27:19 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191456</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191456</guid><description><![CDATA[<p>abstract: Medicare beneficiaries face myriad rules, conditions, and exceptions under the Medicare program. As a result, State Information, Counseling, and Assistance (ICA) programs were established or enhanced with Federal funding as part of the Omnibus Budget Reconciliation Act (OBRA) of 1990. ICA programs utilize a volunteer-based and locally-sponsored support system to deliver free and unbiased counseling on the Medicare program and related health insurance issues. This article discusses the effectiveness of the ICA model. Because the ICA programs serve as a vital link between HCFA and its beneficiaries, information about the programs' success may be useful to HCFA and other policymakers during this era of consumer information.</p><p>authors: Garfinkel, Steven A; Lee, A James; Schnaier, Jenny A</p><p>issue_mesh: Communication : Cost Savings : Counseling/organization &#x26; administration : Financing, Government : Health Services Research/methods : Human : Information Services/economics/organization &#x26; administration : Inservice Training : Insurance Benefits : Medicare/legislation &#x26; jurisprudence/organization &#x26; administration : Outcome Assessment (Health Care) : Program Development : Support, U.S. Gov't, Non-P.H.S. : Training Support : United States : United States Health Care Financing Administration : Voluntary Workers/education</p><p>issue_number: 1</p><p>ntis_number: PB99-106494</p><p>page_range: 127-140</p><p>primary_author: McCormack, Lauren A</p><p>title: Medicare beneficiary counseling programs: what are they and do they work?</p><p>volume: 18</p><p>year_period: 1996 Fall</p>]]></description></item><item><title>Medicare beneficiary information needs: 1994.</title><pubDate>Mon, 04 Nov 2019 02:27:19 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191461</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191461</guid><description><![CDATA[<p>abstract: The Medicare Current Beneficiary Survey (MCBS) is a powerful tool for analyzing enrollees' access to medical care (Adler, 1994). Based on a stratified random sample, we can derive information about the health care use, expenditure, and financing of Medicare's 36 million enrollees. We can also learn about those enrollees' health status, living arrangements, and access to and satisfaction with care. In the charts that follow, we have presented some findings on enrollee information needs in 1994, number of beneficiaries with information needs met, and sources of information used by beneficiaries. These charts attempt to answer the following questions: What types of needs do our beneficiaries have? How well do our beneficiaries understand Medicare?</p><p>authors: Poisal, John A</p><p>issue_mesh: Aged : Data Collection : Health Care Surveys : Health Services Accessibility/statistics &#x26; numerical data : Health Services Needs and Demand/statistics &#x26; numerical data : Human : Information Services/supply &#x26; distribution/statistics &#x26; numerical data : Insurance Benefits : Insurance Coverage : Medicare/organization &#x26; administration/statistics &#x26; numerical data : United States</p><p>issue_number: 1</p><p>ntis_number: PB99-106494</p><p>page_range: 247-252</p><p>primary_author: Eppig, Franklin J</p><p>title: Medicare beneficiary information needs: 1994.</p><p>volume: 18</p><p>year_period: 1996 Fall</p>]]></description></item><item><title>Bringing managed care incentives to Medicare's fee-for-service sector.</title><pubDate>Mon, 04 Nov 2019 02:27:19 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191436</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191436</guid><description><![CDATA[<p>abstract: The Health Care Financing Administration (HCFA) could work with eligible physician organizations to generate savings in total reimbursements for their Medicare patients. Medicare would continue to reimburse all providers according to standard payment policies and mechanisms, and beneficiaries would retain the freedom to choose providers. However, implementation of new financial incentives, based on meeting targets called Group-Specific Volume Performance Standards (GVPS), would encourage cost-effective service delivery patterns. HCFA could use new and existing data systems to monitor access, utilization patterns, cost outcomes and quality of care. In short, HCFA could manage providers, who, in turn, would manage their patients' care.</p><p>authors: Bhalotra, Sarita; Chilingerian, Jon A; Glavin, Mitchell P; Hodgkin, Dominic; Ritter, Grant A; Wallack, Stanley S</p><p>issue_mesh: Reimbursement, Incentive : Relative Value Scales : Capitation Fee : Cost Control : Fee-for-Service Plans/economics/utilization : Health Expenditures : Managed Care Programs/economics/utilization : Medicare Part B/economics/organization &#x26; administration : Support, U.S. Gov't, Non-P.H.S. : United States : United States Health Care Financing Administration : Utilization Review</p><p>issue_number: 4</p><p>ntis_number: PB97-104087</p><p>page_range: 43-63</p><p>primary_author: Tompkins, Christopher P</p><p>title: Bringing managed care incentives to Medicare's fee-for-service sector.</p><p>volume: 17</p><p>year_period: 1996 Summer</p>]]></description></item><item><title>Evaluation of the Arkansas Medicaid primary care physician management program.</title><pubDate>Mon, 04 Nov 2019 02:27:19 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191441</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191441</guid><description><![CDATA[<p>abstract: Arkansas implemented a primary-care case-management program in February 1994. This study evaluates the program during its first 17 months. Using quarterly data collected for the Health Care Financing Administration (HCFA), a pooled cross-sectional time series analysis (1991:4-1995:2) estimates the effect of eligibles' program enrollment on expenditure (total, inpatient hospital, outpatient hospital, physicians, prescription drugs, laboratory and X-ray) and utilization measures (outpatient visits, physician visits, prescription drugs). The Arkansas Medicaid managed care program appears to have somewhat reduced growth in total vendor payments and also appears to have improved access to primary medical services.</p><p>authors: Baker, John A</p><p>issue_mesh: Aid to Families with Dependent Children : Arkansas : Case Management/economics/organization &#x26; administration : Cost Control : Drug Costs : Eligibility Determination : Health Expenditures/statistics &#x26; numerical data : Health Services Research : Health Status Indicators : Medicaid/economics/utilization : Physicians, Family : Primary Health Care/economics/standards/utilization : Program Evaluation : State Health Plans/economics/standards/utilization : Support, Non-U.S. Gov't : United States : United States Health Care Financing Administration : Utilization Review</p><p>issue_number: 4</p><p>ntis_number: PB97-104087</p><p>page_range: 117-133</p><p>primary_author: Muller, Andreas</p><p>title: Evaluation of the Arkansas Medicaid primary care physician management program.</p><p>volume: 17</p><p>year_period: 1996 Summer</p>]]></description></item><item><title>Access to physicians.</title><pubDate>Mon, 04 Nov 2019 02:27:19 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191416</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191416</guid><description><![CDATA[<p>authors: Eppig, Franklin J; Waldo, Daniel R</p><p>issue_mesh: Appointments and Schedules : Health Services Accessibility/economics/statistics &#x26; numerical data : Insurance Benefits : Medicaid/utilization : Medicare Part B/utilization : Office Visits/statistics &#x26; numerical data : Time Factors : Transportation : Travel : United States</p><p>issue_number: 2</p><p>ntis_number: PB96-172663</p><p>page_range: 243-248</p><p>primary_author: Hogan, Mary O</p><p>title: Access to physicians.</p><p>volume: 17</p><p>year_period: 1995 Winter</p>]]></description></item><item><title>Access to care in rural America: impact of hospital closures.</title><pubDate>Mon, 04 Nov 2019 02:27:19 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191388</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191388</guid><description><![CDATA[<p>abstract: This article employs a quasi-experimental, pre/post comparison group design to determine whether rural hospital closures (n = 11) have had a detrimental impact on access to inpatient and outpatient care for the Medicare population. Closure areas experienced a significant decrease in medical admissions, although admission rates remained higher than in comparison areas. Physician services were not found to substitute for inpatient services following a closure. No adverse impacts on mortality were observed. Patients in closure areas were more likely to be admitted to urban teaching hospitals following the closure of their local hospital.</p><p>authors: Dayhoff, Debra A</p><p>issue_mesh: Comparative Study : Health Facility Closure/economics/statistics &#x26; numerical data : Health Services Accessibility/statistics &#x26; numerical data : Health Services Research : Hospitals, Rural/economics/supply &#x26; distribution : Medicare Part A/economics/trends : Medicare Part B/economics/trends : Outcome Assessment (Health Care) : Rural Population : Support, U.S. Gov't, Non-P.H.S. : United States : Utilization Review</p><p>issue_number: 1</p><p>ntis_number: PB96-139548</p><p>page_range: 15-37</p><p>primary_author: Rosenbach, Margo L</p><p>title: Access to care in rural America: impact of hospital closures.</p><p>volume: 17</p><p>year_period: 1995 Fall</p>]]></description></item><item><title>Practice expenses in the MFS (Medicare fee schedule): the service-class approach.</title><pubDate>Mon, 04 Nov 2019 02:27:19 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191368</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191368</guid><description><![CDATA[<p>abstract: The practice expense component of the Medicare fee schedule (MFS), which is currently based on historical charges and rewards physician procedures at the expense of cognitive services, is due to be changed by January 1, 1998. The Physician Payment Review Commission (PPRC) and others have proposed microcosting direct costs and allocating all indirect costs on a common basis, such as physician time or work plus direct costs. Without altering the treatment of direct costs, the service-class approach disaggregates indirect costs into six practice function costs. The practice function costs are then allocated to classes of services using cost-accounting and statistical methods. This approach would make the practice expense component more resource-based than other proposed alternatives.</p><p>authors: Kane, Nancy M</p><p>issue_mesh: Relative Value Scales : Cost Allocation : Data Collection : Fee Schedules/legislation &#x26; jurisprudence/statistics &#x26; numerical data : Medicare Part B/legislation &#x26; jurisprudence : Practice Management, Medical/economics/statistics &#x26; numerical data : Support, U.S. Gov't, Non-P.H.S. : United States</p><p>issue_number: 3</p><p>ntis_number: PB96-139530</p><p>page_range: 197-211</p><p>primary_author: Latimer, Eric A</p><p>title: Practice expenses in the MFS (Medicare fee schedule): the service-class approach.</p><p>volume: 16</p><p>year_period: 1995 Spring</p>]]></description></item><item><title>Consumer information development and use.</title><pubDate>Mon, 04 Nov 2019 02:27:19 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191451</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191451</guid><description><![CDATA[<p>abstract: The availability of informational materials to aid consumer health care purchasing decisions is increasing. Organizations developing and disseminating materials include public- and private-sector employers, providers, purchasing cooperatives, State agencies, counseling programs, and accreditation bodies. Based on case study interviews with 24 organizations, we learned that 10 included consumer satisfaction ratings and performance measures based on medical records. An additional four organizations developed materials with consumer satisfaction ratings exclusively. Printed materials were the most common medium used to convey information to consumers. However, other mechanisms for conveying the information were also employed. On the whole, the materials have not been rigorously evaluated. Evaluations are needed to determine if consumers find the information useful and how different individuals prefer to receive the information.</p><p>authors: Garfinkel, Steven A; Lee, A James; Sangl, Judith A; Schnaier, Jenny A</p><p>issue_mesh: Consumer Participation : Consumer Satisfaction/statistics &#x26; numerical data : Data Collection : Decision Making : Health Benefit Plans, Employee/standards/utilization : Health Services Research/methods : Information Services/organization &#x26; administration/supply &#x26; distribution : Managed Care Programs/standards/utilization : Managed Competition : Outcome and Process Assessment (Health Care)/statistics &#x26; numerical data : Support, U.S. Gov't, Non-P.H.S. : United States : United States Health Care Financing Administration</p><p>issue_number: 1</p><p>ntis_number: PB99-106494</p><p>page_range: 15-30</p><p>primary_author: McCormack, Lauren A</p><p>title: Consumer information development and use.</p><p>volume: 18</p><p>year_period: 1996 Fall</p>]]></description></item><item><title>Medicaid expenditures and state responses.</title><pubDate>Mon, 04 Nov 2019 02:27:19 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191358</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191358</guid><description><![CDATA[<p>abstract: This overview summarizes issues addressed in this issue of the Health Care Financing Review, entitled "Medicaid and State Health Reform." Articles cover the following topics: growth in the level of expenditures for Medicaid and creative financing strategies by States to manage these increases; section 1115 demonstration waivers; States' experiences with implementing approved section 1115 demonstrations; how section 1115 demonstration waivers fit into larger State health reform efforts; and other reform efforts in two States.</p><p>authors: N/A</p><p>issue_mesh: Eligibility Determination : Health Care Reform/legislation &#x26; jurisprudence : Health Expenditures/legislation &#x26; jurisprudence/statistics &#x26; numerical data/trends : Health Services Accessibility : Health Services Research : Medicaid/organization &#x26; administration/statistics &#x26; numerical data/trends/utilization : State Health Plans/economics : United States : United States Health Care Financing Administration</p><p>issue_number: 3</p><p>ntis_number: PB96-139530</p><p>page_range: 1-10</p><p>primary_author: Tudor, Cynthia G</p><p>title: Medicaid expenditures and state responses.</p><p>volume: 16</p><p>year_period: 1995 Spring</p>]]></description></item><item><title>System change: quality assessment and improvement for Medicaid managed care.</title><pubDate>Mon, 04 Nov 2019 02:27:19 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191440</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191440</guid><description><![CDATA[<p>abstract: Rising Medicaid health expenditures have hastened the development of State managed care programs. Methods to monitor and improve health care under Medicaid are changing. Under fee-for-service (FFS), the primary concern was to avoid overutilization. Under managed care, it is to avoid underutilization. Quality enhancement thus moves from addressing inefficiency to addressing insufficiency of care. This article presents a case study of Virginia's redesign of Quality Assessment and Improvement (QA/I) for Medicaid, adapting the guidelines of the Quality Assurance Reform Initiative (QARI) of the Health Care Financing Administration (HCFA). The article concludes that redesigns should emphasize Continuous Quality Improvement (CQI) by all providers and of multi-faceted, population-based data.</p><p>authors: Cotter, James J; Rossiter, Louis F</p><p>issue_mesh: Guidelines : Health Services Accessibility : Health Services Research : Health Status Indicators : Managed Care Programs/organization &#x26; administration/standards/utilization : Medicaid/organization &#x26; administration/standards/utilization : Medical Audit : Patient Satisfaction : Quality Assurance, Health Care/organization &#x26; administration : Reimbursement Mechanisms : State Health Plans/organization &#x26; administration/standards/utilization : Support, Non-U.S. Gov't : United States : Virginia</p><p>issue_number: 4</p><p>ntis_number: PB97-104087</p><p>page_range: 97-115</p><p>primary_author: Smith, Wally R</p><p>title: System change: quality assessment and improvement for Medicaid managed care.</p><p>volume: 17</p><p>year_period: 1996 Summer</p>]]></description></item><item><title>An analysis of selectivity bias in the Medicare AAPCC (adjusted average per capita cost).</title><pubDate>Mon, 04 Nov 2019 02:27:19 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191420</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191420</guid><description><![CDATA[<p>abstract: Using econometric models of endogenous sample selection, we examine possible payment bias to Medicare Tax Equity and Fiscal Responsibility Act of 1982 (TEFRA) risk health maintenance organizations (HMOs) in the Twin Cities in 1988. We do not find statistically significant evidence of favorable HMO selection. In fact, the sign of the selection term indicates adverse selection into HMOs. This finding is interesting, in view of the fact that three of the five risk HMOs in the study have since converted to non-risk contracts.</p><p>authors: Bland, Pat; Feldman, Roger; Finch, Michael; Moscovice, Ira S; Wisner, Catherine</p><p>issue_mesh: Capitation Fee : Insurance Selection Bias : Aged : Chronic Disease/epidemiology : Disability Evaluation : Health Care Costs : Health Maintenance Organizations/economics/standards : Human : Medicare/organization &#x26; administration/statistics &#x26; numerical data : Minnesota : Models, Economic : Regression Analysis : Support, U.S. Gov't, Non-P.H.S. : Tax Equity and Fiscal Responsibility Act : United States : United States Health Care Financing Administration</p><p>issue_number: 3</p><p>ntis_number: PB99-106510</p><p>page_range: 35-57</p><p>primary_author: Dowd, Bryan</p><p>title: An analysis of selectivity bias in the Medicare AAPCC (adjusted average per capita cost).</p><p>volume: 17</p><p>year_period: 1996 Spring</p>]]></description></item><item><title>Adjusting Medicare capitation payments using prior hospitalization data.</title><pubDate>Mon, 04 Nov 2019 02:27:19 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191036</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191036</guid><description><![CDATA[<p>abstract: The diagnostic cost group approach to a reimbursement model for health maintenance organizations is presented. Diagnostic information about previous hospitalizations is used to create empirically determined risk groups, using only diagnoses involving little or no discretion in the decision to hospitalize. Diagnostic cost group and other models (including Medicare's current formula and other prior-use models) are tested for their ability to predict future costs, using R2 values and new measures of predictive performance. The diagnostic cost group models perform relatively well with respect to a range of criteria, including administrative feasibility, resistance to provider manipulation, and statistical accuracy.</p><p>authors: Beiser, Alexa; Gruenberg, Leonard; Porell, Frank W; Sawitz, Eric</p><p>issue_mesh: Capitation Fee : Fees and Charges : Models, Theoretical : Costs and Cost Analysis/trends : Data Collection : Diagnosis-Related Groups/economics : Fee Schedules : Health Maintenance Organizations/economics : Hospitalization/economics : Medicare/organization &#x26; administration : Probability : Reimbursement Mechanisms : Support, U.S. Gov't, Non-P.H.S. : United States</p><p>issue_number: 4</p><p>ntis_number: PB89-232342</p><p>page_range: 17-29</p><p>primary_author: Ash, Arlene S</p><p>title: Adjusting Medicare capitation payments using prior hospitalization data.</p><p>volume: 10</p><p>year_period: 1989 Summer</p>]]></description></item><item><title>Excluded from universal coverage: ESRD patients not covered by Medicare.</title><pubDate>Mon, 04 Nov 2019 02:27:19 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191410</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191410</guid><description><![CDATA[<p>abstract: Medicaid is believed to serve as the major insurer for end stage renal disease (ESRD) patients who are ineligible for Medicare coverage. Demographics, receipt of dialysis services, and costs of Medicaid-only populations were compared with Medicare ESRD populations in California, Georgia, and Michigan. Notable differences in patient demographics, dialysis practice patterns, and inpatient health resource utilization between the Medicaid and Medicare ESRD populations were observed. Medicaid expenditures for Medicare-ineligible ESRD patients were considerable: in 1991, California spent $46.4 million for 1,239 ESRD patients; Georgia and Michigan each spent nearly $5 million for approximately 140 ESRD patients.</p><p>authors: Cotter, Dennis J; Greer, Joel W; Pearson, Brian C; Ray, Nancy F; Richard, Christian</p><p>issue_mesh: Eligibility Determination : Female : Health Expenditures : Health Services Accessibility/economics/statistics &#x26; numerical data : Hemodialysis/economics/utilization : Hospitalization : Human : Kidney Failure, Chronic/economics/therapy : Length of Stay : Male : Medicaid/utilization : Medically Uninsured/statistics &#x26; numerical data : Medicare/utilization : Renal Replacement Therapy/economics/utilization : United States : United States Health Care Financing Administration : Utilization Review</p><p>issue_number: 2</p><p>ntis_number: PB96-172663</p><p>page_range: 123-146</p><p>primary_author: Thamer, Mae</p><p>title: Excluded from universal coverage: ESRD patients not covered by Medicare.</p><p>volume: 17</p><p>year_period: 1995 Winter</p>]]></description></item><item><title>Conventional health insurance: a decade later.</title><pubDate>Mon, 04 Nov 2019 02:27:19 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191030</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191030</guid><description><![CDATA[<p>abstract: In this article, the 1987 conventional health plans are examined and 1987 group health insurance is compared with that of 1977. The source of information for 1987 is the national survey of 771 private and public employers conducted by the Health Insurance Association of America. Data for 1977 are from the National Medical Care Expenditures Survey. Findings show that conventional health plans' share of the group market declined from 95 to 73 percent during the decade; the majority of Americans covered by conventional group insurance are now enrolled in a plan that self-insures; prospective utilization review grew dramatically after 1984; and patient cost sharing increased, but not as significantly as conventional wisdom holds.</p><p>authors: Gabel, Jon R</p><p>issue_mesh: Comparative Study : Data Collection : Deductibles and Coinsurance/trends : Evaluation Studies : Health Benefit Plans, Employee/trends : Insurance Carriers : Insurance Claim Review/trends : Insurance, Health/trends : Statistics : United States</p><p>issue_number: 3</p><p>ntis_number: PB89-208953</p><p>page_range: 87-89</p><p>primary_author: DiCarlo, Steven</p><p>title: Conventional health insurance: a decade later.</p><p>volume: 10</p><p>year_period: 1989 Spring</p>]]></description></item><item><title>Opening remarks</title><pubDate>Mon, 04 Nov 2019 02:27:18 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191464</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191464</guid><description><![CDATA[<p>issue_number: 2</p><p>ntis_number: PB98-110885</p><p>page_range: 1-2</p><p>primary_author: Sherman, Max</p><p>title: Opening remarks</p><p>volume: 18</p><p>year_period: 1996 Winter</p>]]></description></item><item><title>National health expenditure projections, 1994-2005.</title><pubDate>Mon, 04 Nov 2019 02:27:18 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191384</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191384</guid><description><![CDATA[<p>abstract: Using 1993 as a baseline and assuming that current laws and practices continue, the authors project U.S. health expenditures through the year 2005. Annual spending growth has declined since 1990, and, in the scenario reported here, that trend continues in 1994. Growth of health spending increases thereafter, but remains below the average experience of the past decade. Even so, health expenditures grow faster than the gross domestic product (GDP), and by 2005, account for 17.9 percent of the GDP. Unless the system changes, Medicare and Medicaid are projected to pay for an increasing share of total spending during the next decade.</p><p>authors: Waldo, Daniel R</p><p>issue_mesh: Forecasting : Health Expenditures/statistics &#x26; numerical data/trends : Insurance, Health/economics : Medicaid/economics : Medicare/economics : Models, Economic : United States</p><p>issue_number: 4</p><p>ntis_number: PB99-106445</p><p>page_range: 221-242</p><p>primary_author: Burner, Sally T</p><p>title: National health expenditure projections, 1994-2005.</p><p>volume: 16</p><p>year_period: 1995 Summer</p>]]></description></item><item><title>Access to care under physician payment reform: a physician-based analysis.</title><pubDate>Mon, 04 Nov 2019 02:27:18 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191414</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191414</guid><description><![CDATA[<p>abstract: This article reports physician-based measures of access to care during the 3 years surrounding the 1989 physician payment reforms. Analysis was facilitated by a new system of physician identifiers in Medicare claims. Access measures include caseload per physician and related measures of the demographic composition of physicians' clientele, the proportion of physicians performing surgical and other procedures, and the assignment rate. The caseload and assignment measures were stable or improving over time, suggesting that reforms did not harm access. Procedure performance rates tended to decline between 1992 and 1993, but reductions were inversely related to the estimated fee changes, and several may be explainable by other factors.</p><p>authors: N/A</p><p>issue_mesh: Reimbursement Mechanisms : Aged : Blacks/statistics &#x26; numerical data : Fee Schedules : Health Services Accessibility/economics/trends : Human : Medicare Assignment/statistics &#x26; numerical data : Medicare Part B/legislation &#x26; jurisprudence/utilization : Physicians/classification/utilization : Specialties, Medical/economics/statistics &#x26; numerical data : Surgical Procedures, Operative/classification/economics : United States : United States Health Care Financing Administration : Whites/statistics &#x26; numerical data : Workload/statistics &#x26; numerical data</p><p>issue_number: 2</p><p>ntis_number: PB96-172663</p><p>page_range: 195-217</p><p>primary_author: Meadow, Ann</p><p>title: Access to care under physician payment reform: a physician-based analysis.</p><p>volume: 17</p><p>year_period: 1995 Winter</p>]]></description></item><item><title>Effects and effectiveness of telemedicine.</title><pubDate>Mon, 04 Nov 2019 02:27:18 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191394</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191394</guid><description><![CDATA[<p>abstract: The use of telemedicine has recently undergone rapid growth and proliferation. Although the feasibility of many applications has been tested for nearly 30 years, data concerning the costs, effects, and effectiveness of telemedicine are limited. Consequently, the development of a strategy for coverage, payment, and utilization policy has been hindered. Telemedicine continues to expand, and pressure for policy development increases in the context of Federal budget cuts and major changes in health service financing. This article reviews the literature on the effects and medical effectiveness of telemedicine. It concludes with several recommendations for research, followed by a discussion of several specific questions, the answers to which might have a bearing on policy development.</p><p>authors: Kaehny, Margaret M; Sandberg, Elliot J; Schlenker, Robert E; Shaughnessy, Peter W</p><p>issue_mesh: Health Services Accessibility : Health Services Research : Rural Health Services : Cost-Benefit Analysis : Policy Making : Support, U.S. Gov't, Non-P.H.S. : Telemedicine/economics/standards/utilization : United States : Utilization Review</p><p>issue_number: 1</p><p>ntis_number: PB96-139548</p><p>page_range: 115-131</p><p>primary_author: Grigsby, Jim</p><p>title: Effects and effectiveness of telemedicine.</p><p>volume: 17</p><p>year_period: 1995 Fall</p>]]></description></item><item><title>Use of Medicare data to identify incident breast cancer cases.</title><pubDate>Mon, 04 Nov 2019 02:27:18 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191460</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191460</guid><description><![CDATA[<p>abstract: Surveillance, Epidemiology and End Results (SEER) data from the National Cancer Institute (NCI) provide reliable information about cancer incidence. However, because SEER data are geographically limited and have a 2-year time lag, we evaluated whether Medicare data could provide timely information on cancer incidence. Comparing Medicare women hospitalized for breast cancer with women reported to SEER, Medicare data had high specificity (96.6 percent), yet low sensitivity (59.4 percent). We conclude that Medicare hospitalization data can identify incident cases for cancers that usually require inpatient hospitalization. For cancers that often only receive outpatient treatment, such as breast cancer, additional Medicare data, such as physician bills, are needed to understand the entirety of treatment practices.</p><p>authors: Hakim, Rosemarie B; McBean, A Marshall; Riley, Gerald F</p><p>issue_mesh: Aged : Aged, 80 and over : Algorithms : Breast Neoplasms/epidemiology : Female : Health Services Research/methods : Hospitalization/economics : Human : Incidence : Medicare/utilization : SEER Program : Sensitivity and Specificity : United States/epidemiology</p><p>issue_number: 1</p><p>ntis_number: PB99-106494</p><p>page_range: 237-246</p><p>primary_author: Warren, Joan L</p><p>title: Use of Medicare data to identify incident breast cancer cases.</p><p>volume: 18</p><p>year_period: 1996 Fall</p>]]></description></item><item><title>Causes of Medicaid expenditure growth.</title><pubDate>Mon, 04 Nov 2019 02:27:18 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191359</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191359</guid><description><![CDATA[<p>abstract: Expenditures for the Medicaid program grew at the alarming and unexpected average annual rate of nearly 20 percent from 1989 ($58 billion) to 1992 ($113 billion). These statistics raise a critical question: What caused spending to grow so dramatically? Using State-level data from 1984-92, this analysis examines the determinants of Medicaid expenditure growth. The results indicate that Medicaid enrollment, Federal Medicaid policy, and State policy are significantly related to Medicaid expenditure growth. The analysis also finds the prevalence of acquired immunodeficiency syndrome (AIDS) to be significantly related to Medicaid expenditures.</p><p>authors: Berg, Stacy</p><p>issue_mesh: Acquired Immunodeficiency Syndrome/economics/epidemiology : Adult : Child, Preschool : Disabled Persons : Health Expenditures/statistics &#x26; numerical data/trends : Health Policy/economics : Human : Medicaid/statistics &#x26; numerical data/trends/utilization : Models, Economic : State Health Plans/economics : Support, U.S. Gov't, Non-P.H.S. : United States/epidemiology</p><p>issue_number: 3</p><p>ntis_number: PB96-139530</p><p>page_range: 11-25</p><p>primary_author: Wade, Martcia</p><p>title: Causes of Medicaid expenditure growth.</p><p>volume: 16</p><p>year_period: 1995 Spring</p>]]></description></item><item><title>Florida's Medicaid AIDS waiver: an assessment of dimensions of quality.</title><pubDate>Mon, 04 Nov 2019 02:27:17 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191379</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191379</guid><description><![CDATA[<p>abstract: Some State Medicaid agencies have implemented home and community-based waiver programs targeting acquired immunodeficiency syndrome (AIDS) patients. Under these initiatives, State Medicaid agencies can provide home and community-base services to persons with AIDS (PWA) as an alternative to more costly Medicaid-covered institutional care. This article evaluates quality of care under the Florida Medicaid waiver for PWA along two dimensions: program effectiveness and client satisfaction. Clients are generally satisfied with their case managers and the range and availability of services. Case managers appear to be well trained. Moreover, the probability of turnover is quite low, despite heavy caseloads and high mortality. The major difficulty faced by clients and case managers relates to the process of becoming Medicaid eligible.</p><p>authors: Mitchell, Jean M</p><p>issue_mesh: Quality of Health Care : Acquired Immunodeficiency Syndrome/nursing : Case Management/statistics &#x26; numerical data : Community Health Services/statistics &#x26; numerical data/standards/utilization : Eligibility Determination : Female : Florida : Health Services Research/methods : Home Care Services/statistics &#x26; numerical data/standards/utilization : Human : Interviews : Male : Medicaid/statistics &#x26; numerical data/standards/utilization : Patient Satisfaction : Support, Non-U.S. Gov't : United States</p><p>issue_number: 4</p><p>ntis_number: PB99-106445</p><p>page_range: 141-153</p><p>primary_author: Cowart, Marie E</p><p>title: Florida's Medicaid AIDS waiver: an assessment of dimensions of quality.</p><p>volume: 16</p><p>year_period: 1995 Summer</p>]]></description></item><item><title>Overview.</title><pubDate>Mon, 04 Nov 2019 02:27:17 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191465</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191465</guid><description><![CDATA[<p>issue_number: 2</p><p>ntis_number: PB98-110885</p><p>page_range: 3-9</p><p>primary_author: Davis, Margaret H</p><p>title: Overview.</p><p>volume: 18</p><p>year_period: 1996 Winter</p>]]></description></item><item><title>Variations in Medicare access and satisfaction by health status: 1991-93.</title><pubDate>Mon, 04 Nov 2019 02:27:17 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191404</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191404</guid><description><![CDATA[<p>abstract: This article examines Medicare access, use, and satisfaction before and after implementation of the Medicare Fee Schedule (MFS), based on 3 years of data from the Medicare Current Beneficiary Survey (MCBS). Descriptive and multivariate analysis revealed that access has not deteriorated from 1991 to 1993; Medicare beneficiaries are reporting increased satisfaction--especially with the costs of care as well as reporting fewer barriers to care. Moreover, the gaps in levels of satisfaction and frequency of perceived barriers have narrowed among those in better and poorer health, suggesting that the program has become more equitable over time.</p><p>authors: Adamache, Killard W; Khandker, Rezaul K</p><p>issue_mesh: Health Status : Demography : Fee Schedules : Health Services Accessibility/statistics &#x26; numerical data : Health Services Research : Medicare/economics/statistics &#x26; numerical data/utilization : Multivariate Analysis : Patient Satisfaction/statistics &#x26; numerical data : Support, U.S. Gov't, Non-P.H.S. : United States</p><p>issue_number: 2</p><p>ntis_number: PB96-172663</p><p>page_range: 29-49</p><p>primary_author: Rosenbach, Margo L</p><p>title: Variations in Medicare access and satisfaction by health status: 1991-93.</p><p>volume: 17</p><p>year_period: 1995 Winter</p>]]></description></item><item><title>Role of consumer information in today's health care system.</title><pubDate>Mon, 04 Nov 2019 02:27:17 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191449</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191449</guid><description><![CDATA[<p>abstract: This overview discusses articles published in this issue of the Health Care Financing Review, entitled "Consumer Information in a Changing Health Care System." The overview describes several trends promoting more active consumer participation in health decisions and how consumer information facilitates that role. Major issues in developing consumer information are presented, stressing how orientation to consumer needs and use of social marketing techniques can yield improvement. The majority of the articles published in this issue of the Review discuss different aspects of information for choice of health plan, ranging from consumer perspectives on their information needs and their comprehension of quality indicators, to methods used for providing such information, such as direct counseling and comparative health plan performance data. The article concludes with thoughts on how we will know if we succeed in developing effective consumer health information.</p><p>authors: Wolf, Linda F</p><p>issue_mesh: Consumer Participation/trends : Consumer Satisfaction : Decision Making : Health Benefit Plans, Employee/standards : Information Services/standards : Insurance, Health/standards : Managed Care Programs/standards : Outcome Assessment (Health Care) : Quality of Health Care : United States</p><p>issue_number: 1</p><p>ntis_number: PB99-106494</p><p>page_range: 1-8</p><p>primary_author: Sangl, Judith A</p><p>title: Role of consumer information in today's health care system.</p><p>volume: 18</p><p>year_period: 1996 Fall</p>]]></description></item><item><title>Assessing the need, use, and developments in mental health/substance abuse care.</title><pubDate>Mon, 04 Nov 2019 02:27:17 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191480</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191480</guid><description><![CDATA[<p>abstract: This overview presents an introduction to the articles published in this issue of the health care Financing Review, entitled "Mental Health Services and Vulnerable Populations." This article discusses the challenges the mental health and substance abuse (MH/SA) care system is confronted with in terms of equity and efficiency and how the system is responding to these challenges. It further addresses research issues in assessing the need and use of mental health services and summarizes recent activities in the research and evaluation of new delivery and payment systems.</p><p>authors: N/A</p><p>issue_mesh: Health Services Accessibility : Health Services Needs and Demand : Capitation Fee : Human : Managed Care Programs/economics : Mental Disorders/rehabilitation : Mental Health Services/economics/organization &#x26; administration/utilization : Reimbursement Mechanisms : Substance-Related Disorders/rehabilitation : United States</p><p>issue_number: 3</p><p>ntis_number: PB98-110554</p><p>page_range: 1-4</p><p>primary_author: Bae, Jay P</p><p>title: Assessing the need, use, and developments in mental health/substance abuse care.</p><p>volume: 18</p><p>year_period: 1997 Spring</p>]]></description></item><item><title>State health reform and the role of 1115 waivers.</title><pubDate>Mon, 04 Nov 2019 02:27:17 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191365</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191365</guid><description><![CDATA[<p>abstract: This article summarizes the status of State health reform and includes a table of major initiatives undertaken by each State. The Health Care Financing Administration's (HCFA's) role in reviewing State waiver proposals is analyzed, and the author examines why States are likely to continue to seek section 1115 waivers, absent Federal health care reform. The often conflicting roles and responsibilities of Federal and State policy-makers in health reform are explored.</p><p>authors: N/A</p><p>issue_mesh: Group Purchasing : Health Care Reform/economics/statistics &#x26; numerical data : Medicaid/economics/legislation &#x26; jurisprudence/organization &#x26; administration : State Health Plans/economics/legislation &#x26; jurisprudence : Support, U.S. Gov't, Non-P.H.S. : United States : United States Health Care Financing Administration</p><p>issue_number: 3</p><p>ntis_number: PB96-139530</p><p>page_range: 139-149</p><p>primary_author: Riley, Trish</p><p>title: State health reform and the role of 1115 waivers.</p><p>volume: 16</p><p>year_period: 1995 Spring</p>]]></description></item><item><title>Medicare, Medicaid, and the elderly poor.</title><pubDate>Mon, 04 Nov 2019 02:27:17 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191469</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191469</guid><description><![CDATA[<p>authors: Lyons, Barbara</p><p>issue_mesh: Activities of Daily Living : Aged : Deductibles and Coinsurance/statistics &#x26; numerical data : Health Expenditures : Health Services Accessibility/economics : Health Status Indicators : Human : Insurance, Medigap/economics : Medicaid/statistics &#x26; numerical data/utilization : Medicare/statistics &#x26; numerical data/utilization : Office Visits/statistics &#x26; numerical data : Patient Satisfaction/statistics &#x26; numerical data : Poverty/statistics &#x26; numerical data : Program Evaluation : United States</p><p>issue_number: 2</p><p>ntis_number: PB98-110885</p><p>page_range: 61-85</p><p>primary_author: Rowland, Diane</p><p>title: Medicare, Medicaid, and the elderly poor.</p><p>volume: 18</p><p>year_period: 1996 Winter</p>]]></description></item><item><title>Employer-specific versus community-wide report cards: is there a difference?</title><pubDate>Mon, 04 Nov 2019 02:27:17 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191455</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191455</guid><description><![CDATA[<p>abstract: This article describes preliminary results from a natural experiment that tested the impact of report cards on employees. As part of the 1995 enrollment process, some members of the State of Minnesota Employee Group Insurance Program received report cards on the plans offered to them, and others did not. Both groups of employees had a chance to review a second community-wide report card covering all Minnesota plans that had been distributed by an independent organization through local newspapers. Both groups were surveyed before and after they made their health plan selections. We compare the likelihood of seeing, the intensity of reading, and the perceived helpfulness of the first, employer-specific report card with the second, community-wide report card for consumers who make plan selections.</p><p>authors: Adlis, Susan; Dahms, Nanette; Finch, Michael; Fowles, Jinnet B; Kind, Elizabeth A; McGee, Jeanne</p><p>issue_mesh: Consumer Participation : Analysis of Variance : Chi-Square Distribution : Chronic Disease/psychology : Consumer Satisfaction : Health Benefit Plans, Employee/standards : Health Care Surveys : Health Services Research/methods : Human : Information Services/standards : Minnesota : State Government : Support, U.S. Gov't, Non-P.H.S. : United States : Universities</p><p>issue_number: 1</p><p>ntis_number: PB99-106494</p><p>page_range: 111-125</p><p>primary_author: Knutson, David J</p><p>title: Employer-specific versus community-wide report cards: is there a difference?</p><p>volume: 18</p><p>year_period: 1996 Fall</p>]]></description></item><item><title>Diagnostic risk adjustment for Medicaid: the disability payment system.</title><pubDate>Mon, 04 Nov 2019 02:27:17 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191419</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191419</guid><description><![CDATA[<p>abstract: This article describes a system of diagnostic categories that Medicaid programs can use for adjusting capitation payments to health plans that enroll people with disability. Medicaid claims from Colorado, Michigan, Missouri, New York, and Ohio are analyzed to demonstrate that the greater predictability of costs among people with disabilities makes risk adjustment more feasible than for a general population and more critical to creating health systems for people with disability. The application of our diagnostic categories to State claims data is described, including estimated effects on subsequent-year costs of various diagnoses. The challenges of implementing adjustment by diagnosis are explored.</p><p>authors: Dreyfus, Tony; Lee, Lora; Zhou, Zhiyuan</p><p>issue_mesh: Capitation Fee : Adolescence : Adult : Aged : Disability Evaluation : Disabled Persons/classification/statistics &#x26; numerical data : Female : Health Care Costs/statistics &#x26; numerical data : Human : Male : Medicaid/economics/organization &#x26; administration/statistics &#x26; numerical data : Middle Age : Models, Economic : Rate Setting and Review/methods : Regression Analysis : Risk Management : Support, Non-U.S. Gov't : Support, U.S. Gov't, Non-P.H.S. : United States</p><p>issue_number: 3</p><p>ntis_number: PB99-106510</p><p>page_range: 7-33</p><p>primary_author: Kronick, Richard</p><p>title: Diagnostic risk adjustment for Medicaid: the disability payment system.</p><p>volume: 17</p><p>year_period: 1996 Spring</p>]]></description></item><item><title>Condition-specific performance information: assessing salience, comprehension, and approaches for communicating quality.</title><pubDate>Mon, 04 Nov 2019 02:27:17 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191454</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191454</guid><description><![CDATA[<p>abstract: This study assesses how consumers view condition-specific performance measures and builds on an earlier study to test an approach for communicating quality information. The study uses three separate designs: a small experiment, a cross-sectional analysis of survey data, and focus groups. We test whether providing information on the health care context affects consumer understanding of indicators. Focus groups were used to explore how consumers view performance measures. The cross-sectional survey analysis used survey data from the experiment and the focus groups to look at comprehension and the salience of condition-specific performance measures. Findings show that a general consumer population does view condition-specific performance measures as salient. Further, the findings provide evidence that information on the health care context makes a difference in how consumers understand performance measures.</p><p>authors: Jewett, Jacquelyn J; Sofaer, Shoshanna</p><p>issue_mesh: Consumer Participation : Breast Neoplasms/psychology/therapy : Communication : Cross-Sectional Studies : Female : Focus Groups : Health Services Research/methods : Human : Information Services/standards : Patient Satisfaction : Quality of Health Care/classification : Support, Non-U.S. Gov't : United States</p><p>issue_number: 1</p><p>ntis_number: PB99-106494</p><p>page_range: 95-109</p><p>primary_author: Hibbard, Judith H</p><p>title: Condition-specific performance information: assessing salience, comprehension, and approaches for communicating quality.</p><p>volume: 18</p><p>year_period: 1996 Fall</p>]]></description></item><item><title>Profile of persons with disabilities in Medicare and Medicaid.</title><pubDate>Mon, 04 Nov 2019 02:27:17 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191445</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191445</guid><description><![CDATA[<p>abstract: This Data View presents descriptive information on beneficiaries with disabilities in Medicare and Medicaid. Medicare data show that persons with disabilities have more functional limitations, poorer health status, lower incomes, and experience more barriers to health care than aged Medicare beneficiaries. Medicaid data reveal that significant growth in the Medicaid disabled population has led to the disabled outnumbering the Medicaid-eligible elderly. Additionally, Medicaid serves an increasingly younger disabled population and more persons with mental impairments.</p><p>authors: O'Brien, Ellen</p><p>issue_mesh: Demography : Disabled Persons/statistics &#x26; numerical data : Health Care Surveys : Health Expenditures/statistics &#x26; numerical data : Health Services Accessibility/statistics &#x26; numerical data : Health Status Indicators : Human : Insurance Coverage : Managed Care Programs/statistics &#x26; numerical data/utilization : Medicaid/economics/statistics &#x26; numerical data/utilization : Medicare/economics/statistics &#x26; numerical data/utilization : Patient Satisfaction/statistics &#x26; numerical data : Social Security/statistics &#x26; numerical data/utilization : United States : Utilization Review/statistics &#x26; numerical data</p><p>issue_number: 4</p><p>ntis_number: PB97-104087</p><p>page_range: 179-211</p><p>primary_author: Davis, Margaret H</p><p>title: Profile of persons with disabilities in Medicare and Medicaid.</p><p>volume: 17</p><p>year_period: 1996 Summer</p>]]></description></item><item><title>Overview of the Medicare program.</title><pubDate>Mon, 04 Nov 2019 02:27:17 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191221</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191221</guid><description><![CDATA[<p>ntis_number: PB99-106460</p><p>page_range: 1-12</p><p>primary_author: Petrie, John T</p><p>title: Overview of the Medicare program.</p><p>volume: Supp.</p><p>year_period: 1992 Supp.</p>]]></description></item><item><title>Business, households, and government: health spending, 1994.</title><pubDate>Mon, 04 Nov 2019 02:27:17 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191444</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191444</guid><description><![CDATA[<p>abstract: During the 1990s, growth in health care costs slowed considerably, helping to lessen the spending strain on business, government, and households. Although cost growth has slowed, the Federal Government continues to pay an ever-increasing share of the total health care bill. This article reviews important health care spending trends, and for the first time, provides separate estimates of the employer and employee share of the premium costs for employer-sponsored private health insurance. This article also highlights some of the emerging trends in the employer-sponsored insurance market, including managed care, cost-sharing, and employment shifts.</p><p>authors: Braden, Bradley R; McDonnell, Patricia A; Sivarajan, Lekha</p><p>issue_mesh: Data Collection : Employer Health Costs/statistics &#x26; numerical data/trends : Fees and Charges : Financing, Government/statistics &#x26; numerical data/trends : Financing, Personal/statistics &#x26; numerical data/trends : Health Expenditures/statistics &#x26; numerical data/trends : Industry/economics : Insurance, Health/economics : Managed Care Programs/economics : Medicaid/economics : Medicare/economics : Private Sector/economics : Public Sector/economics : United States</p><p>issue_number: 4</p><p>ntis_number: PB97-104087</p><p>page_range: 157-178</p><p>primary_author: Cowan, Cathy A</p><p>title: Business, households, and government: health spending, 1994.</p><p>volume: 17</p><p>year_period: 1996 Summer</p>]]></description></item><item><title>Do transition grants help rural hospitals?</title><pubDate>Mon, 04 Nov 2019 02:27:17 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191389</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191389</guid><description><![CDATA[<p>abstract: Congress introduced the Rural Health Care Transition (RHCT) Grant Program in 1989 to assist financially troubled, small rural hospitals. This article discusses grant effects on the second cohort of hospitals to complete their 3-year grants. Although three-quarters of the grantees implemented all or most of their goals, 11 percent could not implement a viable project. Grantees added or upgraded 523 services with the help of their grants, especially outpatient and social services, most of them financially self-supporting. Except among the largest hospitals, there was no evidence that the grants improved grantee finances. Management appeared unaffected by the grants.</p><p>authors: Cheh, Valerie A; Holden, Nancy; Moreno, Lorenzo; Thompson, Rachel</p><p>issue_mesh: Community Health Services/economics : Emergency Service, Hospital/economics : Financing, Government/legislation &#x26; jurisprudence : Health Services Research/economics/standards : Home Care Services, Hospital-Based/economics : Hospice Care/economics : Hospitals, Rural/economics/organization &#x26; administration : Organizational Objectives : Outpatient Clinics, Hospital/economics : Support, U.S. Gov't, Non-P.H.S. : United States : United States Health Care Financing Administration</p><p>issue_number: 1</p><p>ntis_number: PB96-139548</p><p>page_range: 39-52</p><p>primary_author: Wooldridge, Judith</p><p>title: Do transition grants help rural hospitals?</p><p>volume: 17</p><p>year_period: 1995 Fall</p>]]></description></item><item><title>Health care indicators.</title><pubDate>Mon, 04 Nov 2019 02:27:17 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191369</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191369</guid><description><![CDATA[<p>abstract: This regular feature of the journal includes a discussion of each of the following four topics: community hospital statistics; employment, hours, and earnings in the private health sector; health care prices; and national economic indicators. These statistics are valuable in their own right for understanding the relationship between the health care sector and the overall economy. In addition, they allow us to anticipate the direction and magnitude of health care cost changes prior to the availability of more comprehensive data.</p><p>authors: Heffler, Stephen K; Sensenig, Arthur L</p><p>issue_mesh: Commerce/statistics &#x26; numerical data/trends : Employment/statistics &#x26; numerical data/trends : Forecasting : Health Care Costs/statistics &#x26; numerical data/trends : Hospitals, Community/economics/statistics &#x26; numerical data : Private Sector/economics/statistics &#x26; numerical data : United States</p><p>issue_number: 3</p><p>ntis_number: PB96-139530</p><p>page_range: 213-244</p><p>primary_author: Donham, Carolyn S</p><p>title: Health care indicators.</p><p>volume: 16</p><p>year_period: 1995 Spring</p>]]></description></item><item><title>Impacts of hospital budget limits in Rochester, New York.</title><pubDate>Mon, 04 Nov 2019 02:27:17 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191383</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191383</guid><description><![CDATA[<p>abstract: During 1980-87, eight hospitals in the Rochester, New York area participated in an experimental program to limit total revenue. This article analyzes: increase of costs for Rochester hospitals; trends for inputs and compensation; and cash flow margins. Real expense per case grew annually by about 3 percent less in Rochester. However, after 1984, Medicare prospective payment had an effect of similar size outside Rochester. Some capital inputs to hospital care were restrained, as were wages and particularly benefits. The program did not generally raise or stabilize hospital revenue margins, while the ratio of cash flow to debt trended down. Financial stringency of this program relative to alternatives may have contributed to its end.</p><p>authors: Wong, Herbert S</p><p>issue_mesh: Budgets : Cost Control : Cost of Illness : Diagnosis-Related Groups : Financial Management, Hospital/statistics &#x26; numerical data/trends : Health Services Research/methods : Hospital Costs/statistics &#x26; numerical data/trends : Income/statistics &#x26; numerical data : Models, Economic : Multivariate Analysis : New York : Pilot Projects : Regional Health Planning/economics : Salaries and Fringe Benefits/statistics &#x26; numerical data</p><p>issue_number: 4</p><p>ntis_number: PB99-106445</p><p>page_range: 201-219</p><p>primary_author: Friedman, Bernard</p><p>title: Impacts of hospital budget limits in Rochester, New York.</p><p>volume: 16</p><p>year_period: 1995 Summer</p>]]></description></item><item><title>Shifting the paradigm: monitoring access in Medicare managed care.</title><pubDate>Mon, 04 Nov 2019 02:27:17 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191434</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191434</guid><description><![CDATA[<p>abstract: Medicare managed care enrollment growth points to the need to develop an approach for monitoring access to care for the increasing number of beneficiaries who use these arrangements. This article describes the issues to be addressed in designing a system for monitoring managed care plan enrollees' ability to obtain needed medical care on a timely basis. We review components of the monitoring approach used for traditional fee-for-service (FFS) Medicare, including the conceptual framework, data, measures, and subgroups targeted in monitoring efforts, and discuss the adaptation of that approach for monitoring access in Medicare managed care.</p><p>authors: Colby, David C; Gold, Marsha</p><p>issue_mesh: Health Services Accessibility : Fee-for-Service Plans/utilization : Health Services Needs and Demand : Health Services Research/methods : Insurance Claim Reporting : Managed Care Programs/utilization : Medicare/utilization : Outcome Assessment (Health Care) : United States : Utilization Review/methods/statistics &#x26; numerical data</p><p>issue_number: 4</p><p>ntis_number: PB97-104087</p><p>page_range: 5-21</p><p>primary_author: Docteur, Elizabeth R</p><p>title: Shifting the paradigm: monitoring access in Medicare managed care.</p><p>volume: 17</p><p>year_period: 1996 Summer</p>]]></description></item><item><title>Medicare and hospitals.</title><pubDate>Mon, 04 Nov 2019 02:27:17 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191475</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191475</guid><description><![CDATA[<p>authors: N/A</p><p>issue_mesh: Diagnosis-Related Groups : Economics, Hospital/history/trends : Education, Medical/economics : Health Expenditures/trends : History of Medicine, 20th Cent. : Hospitals, Teaching/economics : Insurance, Health, Reimbursement : Medicare/history/trends : Program Evaluation : United States</p><p>issue_number: 2</p><p>ntis_number: PB98-110885</p><p>page_range: 149-151</p><p>primary_author: Rabkin, Mitchell T</p><p>title: Medicare and hospitals.</p><p>volume: 18</p><p>year_period: 1996 Winter</p>]]></description></item><item><title>Modified capitation and treatment incentives for end stage renal disease.</title><pubDate>Mon, 04 Nov 2019 02:27:17 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191424</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191424</guid><description><![CDATA[<p>abstract: This study developed a modified capitation payment method for the Medicare end stage renal disease (ESRD) program designed to support appropriate treatment choices and protect health plans from undue financial risk. The payment method consists of risk-adjusted monthly capitated payments for individuals on dialysis or with functioning kidney grafts, lump sum event payments for expected incremental costs of kidney transplantations or graft failures, and outlier payments for expensive patients. The methodology explained 25 percent of variation in annual payments per patient. Risk adjustment captured substantial variations across patient groups. Outlier payments reduced health plan risk by up to 15 percent.</p><p>authors: Carter, Grace M; Kallich, Joel D; Lucas, Thomas W; Spritzer, Karen L</p><p>issue_mesh: Capitation Fee : Disability Evaluation : Health Care Costs : Health Maintenance Organizations/economics : Human : Insurance Selection Bias : Kidney Failure, Chronic/economics/epidemiology/surgery : Kidney Transplantation/economics : Medicare/classification/organization &#x26; administration : Models, Economic : Rate Setting and Review/methods : Risk Management : Support, U.S. Gov't, Non-P.H.S. : United States Health Care Financing Administration : United States/epidemiology</p><p>issue_number: 3</p><p>ntis_number: PB99-106510</p><p>page_range: 129-142</p><p>primary_author: Farley, Donna O</p><p>title: Modified capitation and treatment incentives for end stage renal disease.</p><p>volume: 17</p><p>year_period: 1996 Spring</p>]]></description></item><item><title>Border-crossing adjustment and personal health care spending by state.</title><pubDate>Mon, 04 Nov 2019 02:27:17 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191459</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191459</guid><description><![CDATA[<p>abstract: This article presents the results of a pioneering effort by the Health Care Financing Administration (HCFA) to measure interstate border crossing for services used by Medicare and non-Medicare beneficiaries. A major focus is to provide estimates of per capita expenditures by State for individual services. Such estimates are not possible without adjustment for interstate border-crossing flows. This is HCFA's first attempt to furnish a unified per capita personal health care expenditures data base comprising all services and covering total population. The study also analyzes interstate differences in expenditure flows by computing rates of inflow and outflow of expenditures, and highlights Medicare/non-Medicare flow differences.</p><p>authors: N/A</p><p>issue_mesh: Catchment Area (Health)/economics/statistics &#x26; numerical data : Health Expenditures/classification/statistics &#x26; numerical data : Health Services Research/methods : Insurance, Health/utilization : Medically Uninsured/statistics &#x26; numerical data : Medicare/utilization : Personal Health Services/economics/utilization : Seasons : Travel : United States : United States Health Care Financing Administration</p><p>issue_number: 1</p><p>ntis_number: PB99-106494</p><p>page_range: 215-236</p><p>primary_author: Basu, Joy</p><p>title: Border-crossing adjustment and personal health care spending by state.</p><p>volume: 18</p><p>year_period: 1996 Fall</p>]]></description></item><item><title>Physician payment and cost containment: perspectives from the U.S. and abroad.</title><pubDate>Mon, 04 Nov 2019 02:27:16 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191261</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191261</guid><description><![CDATA[<p>authors: N/A</p><p>issue_mesh: Cost Control : Insurance, Physician Services : Medicare : United States</p><p>issue_number: 3</p><p>ntis_number: PB95-111274</p><p>page_range: 1-4</p><p>primary_author: Antos, Joseph R</p><p>title: Physician payment and cost containment: perspectives from the U.S. and abroad.</p><p>volume: 14</p><p>year_period: 1993 Spring</p>]]></description></item><item><title>Agreement between physicians' office records and Medicare Part B claims data.</title><pubDate>Mon, 04 Nov 2019 02:27:16 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191382</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191382</guid><description><![CDATA[<p>abstract: This article tests agreement between demographic, diagnostic, and procedural information from primary-care physicians' office records and Medicare Part B claims for Maryland Medicare beneficiaries. The extent of agreement depended on the category of information being compared. Demographics matched poorly, probably due to incomplete record samples. Important diagnoses were often missing from the medical record. When claims indicated presence of disease, the patient was likely to have the disease, but claims did not capture all people who have the disease. Additionally, many laboratory tests and procedures were missing from the primary-care record. The appropriate use of either of these data sources depends on the specific research question that is being asked.</p><p>authors: Garnick, Deborah W; Lawthers, Ann G; Palmer, R Heather; Petrie, Doris S; Weiner, Jonathan P</p><p>issue_mesh: Demography : Diagnostic Tests, Routine : Eligibility Determination : Insurance Claim Reporting/statistics &#x26; numerical data/standards : Maryland : Medical Records/statistics &#x26; numerical data/standards : Medicare Part B/organization &#x26; administration : Practice Management, Medical/standards : Support, U.S. Gov't, Non-P.H.S. : United States</p><p>issue_number: 4</p><p>ntis_number: PB99-106445</p><p>page_range: 189-199</p><p>primary_author: Fowles, Jinnet B</p><p>title: Agreement between physicians' office records and Medicare Part B claims data.</p><p>volume: 16</p><p>year_period: 1995 Summer</p>]]></description></item><item><title>Health care indicators.</title><pubDate>Mon, 04 Nov 2019 02:27:16 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191385</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191385</guid><description><![CDATA[<p>abstract: This regular feature of the journal includes a discussion of each of the following four topics: community hospital statistics; employment, hours, and earnings in the private health sector; health care prices; and national economic indicators. These statistics are valuable in their own right for understanding the relationship between the health care sector and the overall economy. In addition, they allow us to anticipate the direction and magnitude of health care cost changes prior to the availability of more comprehensive data.</p><p>authors: Heffler, Stephen K; Sensenig, Arthur L</p><p>issue_mesh: Commerce/statistics &#x26; numerical data/trends : Economics : Employment/economics/statistics &#x26; numerical data : Forecasting : Health Care Costs/statistics &#x26; numerical data : Hospitals, Community/economics/statistics &#x26; numerical data : Private Sector/economics/standards : United States</p><p>issue_number: 4</p><p>ntis_number: PB99-106445</p><p>page_range: 243-272</p><p>primary_author: Donham, Carolyn S</p><p>title: Health care indicators.</p><p>volume: 16</p><p>year_period: 1995 Summer</p>]]></description></item><item><title>Medicaid managed care encounter data: what, why, and where next?</title><pubDate>Mon, 04 Nov 2019 02:27:16 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191439</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191439</guid><description><![CDATA[<p>abstract: Managed care now serves 23 percent of the Medicaid population. With the shift to capitation, the fee-for-service (FFS) billing mechanism that has generated much of the administrative data used in policy planning and research no longer exists. This article provides an overview of the types of encounter data currently being required for plans and the problems and issues with providing and analyzing such data. It is based on a review of documentation and interviews with representatives of nine States and the Health Care Financing Administration (HCFA). The article concludes by providing recommendations for HCFA, States, and plans in creating and improving encounter data systems.</p><p>authors: N/A</p><p>issue_mesh: Capitation Fee : Data Collection/standards : Documentation/standards : Health Services Accessibility : Health Services Research : Insurance Claim Reporting/standards : Managed Care Programs/economics/organization &#x26; administration/utilization : Medicaid/organization &#x26; administration/utilization : Quality of Health Care : State Health Plans/organization &#x26; administration/utilization : United States : Utilization Review/organization &#x26; administration</p><p>issue_number: 4</p><p>ntis_number: PB97-104087</p><p>page_range: 87-95</p><p>primary_author: Howell, Embry M</p><p>title: Medicaid managed care encounter data: what, why, and where next?</p><p>volume: 17</p><p>year_period: 1996 Summer</p>]]></description></item><item><title>Medicare spending by state: the border-crossing adjustment.</title><pubDate>Mon, 04 Nov 2019 02:27:16 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191415</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191415</guid><description><![CDATA[<p>abstract: As the first step in a pioneering effort by the Health Care Financing Administration (HCFA) to measure interstate border crossing for services used by both Medicare and non-Medicare beneficiaries, the authors study the spending behavior of Medicare beneficiaries for 10 Medicare-covered services. Based on interstate flow-of-expenditure data developed for calendar year 1991, the authors analyze the spending patterns of State residents by studying the inflow and outflow rates and the netflow ratios of expenditures incurred by Medicare patients. The report also provides per capita expenditure estimates with residence-based adjustments and evaluates the impact of the border-crossing adjustment for individual services and States.</p><p>authors: Lazenby, Helen C; Levit, Katharine R</p><p>issue_mesh: Catchment Area (Health)/economics/statistics &#x26; numerical data : Health Expenditures/statistics &#x26; numerical data : Health Services Accessibility/economics/statistics &#x26; numerical data : Health Services Research : Medicare/statistics &#x26; numerical data/utilization : Personal Health Services/economics/statistics &#x26; numerical data/utilization : Travel : United States : United States Health Care Financing Administration</p><p>issue_number: 2</p><p>ntis_number: PB96-172663</p><p>page_range: 219-241</p><p>primary_author: Basu, Joy</p><p>title: Medicare spending by state: the border-crossing adjustment.</p><p>volume: 17</p><p>year_period: 1995 Winter</p>]]></description></item><item><title>Thirty years of Medicare: impact on the covered population.</title><pubDate>Mon, 04 Nov 2019 02:27:16 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191479</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191479</guid><description><![CDATA[<p>authors: Cooper, Barbara S; Davis, Margaret H; DeLew, Nancy; Eggers, Paul W; Lubitz, James; Warren, Joan L</p><p>issue_mesh: Aged : Anniversaries and Special Events : Demography : Disabled Persons : Eligibility Determination : Health Services for the Aged/economics/legislation &#x26; jurisprudence : Health Status : History of Medicine, 20th Cent. : Human : Insurance Coverage/legislation &#x26; jurisprudence : Medicare Part A/history/legislation &#x26; jurisprudence/trends : Medicare Part B/history/legislation &#x26; jurisprudence/trends : Program Evaluation : United States</p><p>issue_number: 2</p><p>ntis_number: PB98-110885</p><p>page_range: 179-237</p><p>primary_author: Gornick, Marian</p><p>title: Thirty years of Medicare: impact on the covered population.</p><p>volume: 18</p><p>year_period: 1996 Winter</p>]]></description></item><item><title>Geographic classification of hospitals: alternative labor market areas.</title><pubDate>Mon, 04 Nov 2019 02:27:16 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191251</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191251</guid><description><![CDATA[<p>abstract: Medicare hospital payments are adjusted to reflect variation in hospital wages across geographic areas by grouping hospitals into labor market areas. By only recognizing the average wage in an area, Medicare encourages hospitals to contain costs. Labor market area definitions have recently received renewed attention because of their impact on hospital payments. Alternative labor market areas were evaluated using several criteria, including ability to explain wage variation and impact on payment equity. Rural labor market areas can be improved using county population size; however, further research on urban labor market areas is needed.</p><p>authors: N/A</p><p>issue_mesh: Catchment Area (Health) : Comparative Study : Data Collection : Geography : Hospitals, Rural/classification/economics/statistics &#x26; numerical data : Hospitals, Urban/classification/economics/statistics &#x26; numerical data : Medicare Part A/economics/statistics &#x26; numerical data : Personnel, Hospital/economics : Prospective Payment System/economics/standards : Rate Setting and Review/standards : Salaries and Fringe Benefits/legislation &#x26; jurisprudence/statistics &#x26; numerical data : United States</p><p>issue_number: 2</p><p>ntis_number: PB2001-105739</p><p>page_range: 49-58</p><p>primary_author: DeLew, Nancy</p><p>title: Geographic classification of hospitals: alternative labor market areas.</p><p>volume: 14</p><p>year_period: 1992 Winter</p>]]></description></item><item><title>The house that Medicare built: remodeling for the 21st century.</title><pubDate>Mon, 04 Nov 2019 02:27:16 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191474</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191474</guid><description><![CDATA[<p>authors: N/A</p><p>issue_mesh: Capitation Fee : Delivery of Health Care/organization &#x26; administration/standards : Eligibility Determination : History of Medicine, 20th Cent. : Information Management : Managed Care Programs/economics : Managed Competition : Medicare/history/organization &#x26; administration/trends : Models, Organizational : Program Evaluation : Support, Non-U.S. Gov't : Tax Equity and Fiscal Responsibility Act : United States : United States Health Care Financing Administration</p><p>issue_number: 2</p><p>ntis_number: PB98-110885</p><p>page_range: 131-145</p><p>primary_author: Greenlick, Merwyn R</p><p>title: The house that Medicare built: remodeling for the 21st century.</p><p>volume: 18</p><p>year_period: 1996 Winter</p>]]></description></item><item><title>National health expenditures, 1994.</title><pubDate>Mon, 04 Nov 2019 02:27:16 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191429</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191429</guid><description><![CDATA[<p>abstract: This article presents data on health care spending for the United States, covering expenditures for various types of medical services and products and their sources of funding from 1960 to 1994. Although these statistics for 1994 show the slowest growth in more than three decades, health spending continued to grow faster than the overall economy. The Federal Government continued to fund an increasing share of health care expenditures in 1994, offset by a falling share from out-of-pocket sources. Shares paid by State and local governments and by other private payers including private health insurance remained unchanged from 1993.</p><p>authors: Braden, Bradley R; Cowan, Cathy A; Donham, Carolyn S; Lazenby, Helen C; Long, Anna M; McDonnell, Patricia A; Sensenig, Arthur L; Sivarajan, Lekha; Stewart, Madie W; Stiller, Jean M; Won, Darleen K</p><p>issue_mesh: Ambulatory Care/economics : Comparative Study : Data Collection : Financing, Government/statistics &#x26; numerical data : Financing, Personal/statistics &#x26; numerical data : Health Care Costs/statistics &#x26; numerical data : Health Expenditures/statistics &#x26; numerical data : Hospital Costs : Insurance, Health/statistics &#x26; numerical data : Medicaid/statistics &#x26; numerical data : Medicare/statistics &#x26; numerical data : Private Sector : United States : United States Health Care Financing Administration</p><p>issue_number: 3</p><p>ntis_number: PB99-106510</p><p>page_range: 205-242</p><p>primary_author: Levit, Katharine R</p><p>title: National health expenditures, 1994.</p><p>volume: 17</p><p>year_period: 1996 Spring</p>]]></description></item><item><title>Provision of home dialysis by freestanding renal dialysis facilities.</title><pubDate>Mon, 04 Nov 2019 02:27:16 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191409</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191409</guid><description><![CDATA[<p>abstract: This article explores home dialysis provision among freestanding renal facilities by examining whether they provide continuous ambulatory peritoneal dialysis (CAPD), continuous cycling peritoneal dialysis (CCPD), and home hemodialysis. These modalities require fewer visits to a dialysis center, which may be beneficial for patients living long distances from facilities. A negative association was found between the number of facilities per square mile and the probability of provision of the home modalities. Secondly, facilities with a higher percent of black patients were less likely to provide the home modalities. Thirdly, facilities with larger numbers of patients were more likely to provide the home modalities.</p><p>authors: N/A</p><p>issue_mesh: Ambulatory Care Facilities/organization &#x26; administration/statistics &#x26; numerical data : Blacks/statistics &#x26; numerical data : Female : Health Services Accessibility/statistics &#x26; numerical data : Health Services Research : Hemodialysis, Home/economics/utilization : Human : Male : Medicare/statistics &#x26; numerical data/utilization : Outpatients/classification : Ownership : Peritoneal Dialysis, Continuous Ambulatory/economics/utilization : Regression Analysis : United States : United States Health Care Financing Administration : Whites/statistics &#x26; numerical data</p><p>issue_number: 2</p><p>ntis_number: PB96-172663</p><p>page_range: 105-122</p><p>primary_author: Kendix, Michael</p><p>title: Provision of home dialysis by freestanding renal dialysis facilities.</p><p>volume: 17</p><p>year_period: 1995 Winter</p>]]></description></item><item><title>Perspectives on home care quality.</title><pubDate>Mon, 04 Nov 2019 02:27:16 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191337</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191337</guid><description><![CDATA[<p>abstract: Home care quality assurance (QA) must consider features inherent in home care, including: multiple goals, limited provider control, and unique family roles. Successive panels of stakeholders were asked to rate the importance of selected home care outcomes. Most highly rated outcomes were freedom from exploitation, satisfaction with care, physical safety, affordability, and physical functioning. Panelists preferred outcome indicators to process and structure, and all groups emphasized "enabling" criteria. Themes highlighted included: interpersonal components of care; normalizing life for clientele; balancing quality of life with safety; developing flexible, negotiated care plans; mechanisms for accountability and case management. These themes were formulated differently according to the stakeholders' role. Providers preferred intermediate outcomes, akin to process.</p><p>authors: Eustis, Nancy N; Illston, Laurel H; Kane, Robert L</p><p>issue_mesh: Data Collection : Focus Groups : Health Priorities/statistics &#x26; numerical data : Health Services Research : Home Care Services/organization &#x26; administration/statistics &#x26; numerical data/standards : Outcome Assessment (Health Care)/statistics &#x26; numerical data : Quality Assurance, Health Care/organization &#x26; administration/statistics &#x26; numerical data : Support, U.S. Gov't, Non-P.H.S. : United States</p><p>issue_number: 1</p><p>ntis_number: PB2001-105546</p><p>page_range: 69-89</p><p>primary_author: Kane, Rosalie A</p><p>title: Perspectives on home care quality.</p><p>volume: 16</p><p>year_period: 1994 Fall</p>]]></description></item><item><title>Using chronic disease risk factors to adjust Medicare capitation payments.</title><pubDate>Mon, 04 Nov 2019 02:27:16 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191241</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191241</guid><description><![CDATA[<p>abstract: This study evaluates the use of risk factors for chronic disease as health status adjusters for Medicare's capitation formula, the average adjusted per capita costs (AAPCC). Risk factor data for the surviving members of the Framingham Study cohort who were examined in 1982-83 were merged with 100 percent Medicare payment data for 1984 and 1985, matching on Social Security number and sex. Seven different AAPCC models were estimated to assess the independent contributions of risk factors and measures of prior utilization and disability in increasing the explanatory power of AAPCC. The findings suggest that inclusion of risk factors for chronic disease as health status adjusters can improve substantially the predictive accuracy of AAPCC.</p><p>authors: Cobb, Janet; Howland, Jonathan</p><p>issue_mesh: Aged : Capitation Fee/trends : Chronic Disease/economics/epidemiology : Data Collection : Female : Forecasting : Health Maintenance Organizations/economics : Human : Male : Massachusetts/epidemiology : Medical Record Linkage : Medicare/economics : Models, Statistical : Rate Setting and Review/methods : Regression Analysis : Risk Factors : Support, Non-U.S. Gov't : Support, U.S. Gov't, P.H.S. : United States</p><p>issue_number: 1</p><p>ntis_number: PB95-123279</p><p>page_range: 79-90</p><p>primary_author: Schauffler, Helen H</p><p>title: Using chronic disease risk factors to adjust Medicare capitation payments.</p><p>volume: 14</p><p>year_period: 1992 Fall</p>]]></description></item><item><title>Profiling resource use by primary-care practices: managed Medicare implications.</title><pubDate>Mon, 04 Nov 2019 02:27:16 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191435</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191435</guid><description><![CDATA[<p>abstract: Variations in elderly Medicare beneficiaries' health service use are examined using a 100-percent sample of fee-for-service (FFS) claims data from Alabama, Iowa, and Maryland. Provider specialty, group practice type, practice size, and location are found to be significant factors affecting hospital and ambulatory care utilization and cost, after controlling for patient and regional characteristics. These results provide insights into utilization and cost expectations from different types of primary-care gatekeepers as the Medicare managed care market develops.</p><p>authors: Fowles, Jinnet B; Garnick, Deborah W; Lawthers, Ann G; Palmer, R Heather; Weiner, Jonathan P</p><p>issue_mesh: Aged : Alabama : Fee-for-Service Plans : Health Services Research/methods : Human : Insurance Claim Review : Iowa : Least-Squares Analysis : Managed Care Programs/utilization : Maryland : Medicare Part A/utilization : Medicare Part B/utilization : Multivariate Analysis : Primary Health Care/economics/utilization : Referral and Consultation/utilization : Support, U.S. Gov't, Non-P.H.S. : United States : Utilization Review/methods</p><p>issue_number: 4</p><p>ntis_number: PB97-104087</p><p>page_range: 23-42</p><p>primary_author: Parente, Stephen T</p><p>title: Profiling resource use by primary-care practices: managed Medicare implications.</p><p>volume: 17</p><p>year_period: 1996 Summer</p>]]></description></item><item><title>A description of Medicaid-covered services.</title><pubDate>Mon, 04 Nov 2019 02:27:16 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191231</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191231</guid><description><![CDATA[<p>ntis_number: PB99-106460</p><p>page_range: 227-234</p><p>primary_author: Gurny, Paul</p><p>title: A description of Medicaid-covered services.</p><p>volume: Supp.</p><p>year_period: 1992 Supp.</p>]]></description></item><item><title>Health insurance and the elderly: data from MCBS (Medicare Current Beneficiary Survey).</title><pubDate>Mon, 04 Nov 2019 02:27:16 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191271</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191271</guid><description><![CDATA[<p>abstract: This article shows the supplemental insurance distribution and Medicare spending per capita by insurance status for elderly persons in 1991. The data are from the Medicare Current Beneficiary Survey (MCBS) and Medicare bill records. Persons with Medicare only are a fairly small share of the elderly (11.4 percent). About three-fourths of the Medicare elderly have some form of private insurance. The share with Medicaid is 11.9 percent, which has increased recently as qualified Medicare beneficiaries (QMBs) started to receive partial Medicaid benefits. In general, Medicare per capita spending levels increase as supplemental insurance comes closer to first dollar coverage. When the data were recalculated to control for differences in reported health status between the insurance groups, essentially the same spending differences were observed.</p><p>authors: Arnett 3d, Ross H; Eppig, Franklin J; Hogan, Mary O; Waldo, Daniel R</p><p>issue_mesh: Age Factors : Aged : Blacks/statistics &#x26; numerical data : Data Collection : Female : Health Expenditures/statistics &#x26; numerical data : Health Status : Human : Insurance, Medigap/statistics &#x26; numerical data/utilization : Male : Medicare/statistics &#x26; numerical data/utilization : Sex Factors : United States : Whites/statistics &#x26; numerical data</p><p>issue_number: 3</p><p>ntis_number: PB95-111274</p><p>page_range: 163-181</p><p>primary_author: Chulis, George S</p><p>title: Health insurance and the elderly: data from MCBS (Medicare Current Beneficiary Survey).</p><p>volume: 14</p><p>year_period: 1993 Spring</p>]]></description></item><item><title>Access of rural AFDC Medicaid beneficiaries to mental health services.</title><pubDate>Mon, 04 Nov 2019 02:27:16 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191395</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191395</guid><description><![CDATA[<p>abstract: This article examines geographic differences in the use of mental health services among Aid to Families with Dependent Children (AFDC)-eligible Medicaid beneficiaries in Maine. Findings indicate that rural AFDC beneficiaries have significantly lower utilization of mental health services than urban beneficiaries. Specialty mental health providers account for the majority of ambulatory visits for both rural and urban beneficiaries. However, rural beneficiaries rely more on primary-care providers than do urban beneficiaries. Differences in use are largely explained by variations in the supply of specialty mental health providers. This finding supports the long-held assumption that lower supply is a barrier to access to mental health services in rural areas.</p><p>authors: Agger, Marc S</p><p>issue_mesh: Aid to Families with Dependent Children/economics/utilization : Geography : Health Services Accessibility/statistics &#x26; numerical data : Human : Maine/epidemiology : Medicaid/economics/utilization : Mental Disorders/epidemiology : Mental Health Services/economics/utilization : Rural Health Services/economics/utilization : Support, Non-U.S. Gov't : Support, U.S. Gov't, P.H.S. : United States/epidemiology</p><p>issue_number: 1</p><p>ntis_number: PB96-139548</p><p>page_range: 133-145</p><p>primary_author: Lambert, David</p><p>title: Access of rural AFDC Medicaid beneficiaries to mental health services.</p><p>volume: 17</p><p>year_period: 1995 Fall</p>]]></description></item><item><title>Quality of care in teaching nursing homes: findings and implications.</title><pubDate>Mon, 04 Nov 2019 02:27:16 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191375</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191375</guid><description><![CDATA[<p>abstract: This article explores policy implications and selected methodological topics relating to long-term care (LTC) quality. We first discuss the Teaching Nursing Home Program (TNHP), in which quality of care in teaching nursing homes (TNHs) was found to be superior to the quality of care in comparison nursing homes (CNHs). A combination of outcome and process/structural measures was used to evaluate the effects of care and underlying reasons for superior TNH outcomes. Second, we explore policy and analytic ramifications. Conceptual, methodological, and applied issues in measuring and improving the quality of LTC are discussed in the context of TNH research and related research in home care.</p><p>authors: Hittle, David F; Kramer, Andrew M; Steiner, John F</p><p>issue_mesh: Comparative Study : Education, Nursing/organization &#x26; administration : Evaluation Studies : Health Services Research : Hospitalization/statistics &#x26; numerical data : Long-Term Care/standards : Nursing Homes/standards : Organizational Affiliation : Outcome Assessment (Health Care)/statistics &#x26; numerical data : Prospective Studies : Quality of Health Care/statistics &#x26; numerical data : Schools, Nursing : Support, Non-U.S. Gov't : Support, U.S. Gov't, Non-P.H.S. : United States</p><p>issue_number: 4</p><p>ntis_number: PB99-106445</p><p>page_range: 55-83</p><p>primary_author: Shaughnessy, Peter W</p><p>title: Quality of care in teaching nursing homes: findings and implications.</p><p>volume: 16</p><p>year_period: 1995 Summer</p>]]></description></item><item><title>Physician payment reform under Medicare: monitoring utilization and access.</title><pubDate>Mon, 04 Nov 2019 02:27:14 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191267</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191267</guid><description><![CDATA[<p>abstract: The Omnibus Budget Reconciliation Act (OBRA) of 1989 brought about significant changes in physician payment policy under Medicare. A major component of physician payment reform was the implementation on January 1, 1992, of the Medicare fee schedule (MFS). The Secretary of Health and Human Services is required to monitor and report annually on the impact of the changes in physician payment on access to and utilization of health care services. This article provides an overview of the 1993 Report to Congress. First, the article discusses the changes made in physician payment policy as well as the complexities involved in assessing the effects of the MFS. Next, the article discusses the approaches that were implemented in the Health Care Financing Administration (HCFA) to generate timely data to monitor and evaluate the impact of physician payment reform on Medicare beneficiaries. Last, the article describes six analyses that were designed to provide differing perspectives for understanding the impact of the OBRA 1989 physician payment changes on access and utilization. Some of the most salient results of these analyses are presented, including preliminary data from the first year during which the MFS was in effect.</p><p>authors: N/A</p><p>issue_mesh: Adolescence : Adult : Aged : Ambulatory Care/utilization : Data Collection : Fee Schedules/legislation &#x26; jurisprudence : Health Care Reform/economics : Health Services Accessibility/economics/trends : Health Services Research : Human : Medicare Part B/economics/utilization : Middle Age : Patient Discharge/statistics &#x26; numerical data : Patient Satisfaction/statistics &#x26; numerical data : Physicians/supply &#x26; distribution : Program Evaluation/statistics &#x26; numerical data : Rate Setting and Review/legislation &#x26; jurisprudence : Socioeconomic Factors : United States : Utilization Review/economics/trends</p><p>issue_number: 3</p><p>ntis_number: PB95-111274</p><p>page_range: 77-96</p><p>primary_author: Gornick, Marian</p><p>title: Physician payment reform under Medicare: monitoring utilization and access.</p><p>volume: 14</p><p>year_period: 1993 Spring</p>]]></description></item><item><title>Hospital wage and price controls: lessons from the Economic Stabilization Program.</title><pubDate>Mon, 04 Nov 2019 02:27:14 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191347</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191347</guid><description><![CDATA[<p>abstract: The Clinton Administration has implied that short-run failures to control health care costs may cause a reexamination of wage and price controls as elements of comprehensive health care reform. The most recent imposition of mandatory wage and price controls was the Economic Stabilization Program (ESP) of the early 1970s. We analyze trends in hospitals' economic behavior and utilization before, during, and after ESP. We also review the relevant literature to estimate ESP's impact, considering other factors that influence hospital behavior. Noting important changes in the hospital industry since the 1970s, we conclude that ESP had limited effect and that similar controls would have little effect today.</p><p>authors: Coit, Anne J; Gabay, Mary; Gaumer, Gary L</p><p>issue_mesh: Cost Control/legislation &#x26; jurisprudence/trends : Cost-Benefit Analysis : Data Collection : Health Care Reform/economics : Hospital Charges/legislation &#x26; jurisprudence/statistics &#x26; numerical data : Income/statistics &#x26; numerical data : Inflation, Economic : Rate Setting and Review : Salaries and Fringe Benefits/legislation &#x26; jurisprudence/statistics &#x26; numerical data : Support, U.S. Gov't, Non-P.H.S. : United States</p><p>issue_number: 2</p><p>ntis_number: PB99-106486</p><p>page_range: 13-43</p><p>primary_author: Ozminkowski, Ronald J</p><p>title: Hospital wage and price controls: lessons from the Economic Stabilization Program.</p><p>volume: 16</p><p>year_period: 1994 Winter</p>]]></description></item><item><title>Creating a MEDPAR (Medicare provider analysis and review) analog to the RUG-III (Resource Utilization Groups, Version III) classification system.</title><pubDate>Mon, 04 Nov 2019 02:27:14 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191351</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191351</guid><description><![CDATA[<p>abstract: As Medicare payments for post-acute institutional care continue to rise sharply, policy interest in the clinical characteristics of beneficiaries admitted to nursing homes and their variation across facilities has stimulated research into case mix. Measures of Medicare skilled nursing facility (SNF) case mix are important in relating payments to the care requirements of residents. The Resource Utilization Groups, Version III (RUG-III) classification system uses a new minimum data set that is not currently available nationally. In preparation for a multi-State demonstration, we needed to simulate at least the first-level splits at the national, State, and facility level. Therefore, we developed proxy measures using comparable data available on the National Claims History files. The analog is an easily programmed measure of the acuity/severity of beneficiaries' conditions across a Medicare Part A SNF stay in 75 percent of the SNF providers. This can be a method for estimating changes in case mix over the years, and differences across provider types and States.</p><p>authors: Feldman, Janet; Liu, Korbin; Marsteller, Jill A</p><p>issue_mesh: Activities of Daily Living : Aged : Diagnosis-Related Groups/classification/economics : Health Services Research : Human : Long-Term Care/classification : Medicare Part A/classification/economics : Rehabilitation/classification : Reimbursement Mechanisms/trends : Skilled Nursing Facilities/economics/utilization : Support, U.S. Gov't, Non-P.H.S. : United States</p><p>issue_number: 2</p><p>ntis_number: PB99-106486</p><p>page_range: 101-126</p><p>primary_author: Cornelius, Elizabeth S</p><p>title: Creating a MEDPAR (Medicare provider analysis and review) analog to the RUG-III (Resource Utilization Groups, Version III) classification system.</p><p>volume: 16</p><p>year_period: 1994 Winter</p>]]></description></item><item><title>Supplementary medical insurance benefit for physician and supplier services.</title><pubDate>Mon, 04 Nov 2019 02:27:14 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191227</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191227</guid><description><![CDATA[<p>ntis_number: PB99-106460</p><p>page_range: 149-181</p><p>primary_author: Helbing, Charles</p><p>title: Supplementary medical insurance benefit for physician and supplier services.</p><p>volume: Supp.</p><p>year_period: 1992 Supp.</p>]]></description></item><item><title>Administrative costs in selected industrialized countries.</title><pubDate>Mon, 04 Nov 2019 02:27:14 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191219</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191219</guid><description><![CDATA[<p>abstract: The costs of health administration are compared across several countries, accompanied by discussion of some of the variations in the definition of health administration. The influence of American health accounting on other countries is examined, and findings are presented regarding the relative costs of insurance-based and direct-delivery systems. Data are presented on health administrative spending providing gross as well as per capita measures.</p><p>authors: N/A</p><p>issue_mesh: Accounting/methods : Comparative Study : Cost Allocation/statistics &#x26; numerical data : Data Collection/methods : Delivery of Health Care/economics/organization &#x26; administration : Europe : Health Expenditures/statistics &#x26; numerical data : Hospital Administration/economics : Insurance, Health/economics : Private Sector/economics : Public Sector/economics : Support, Non-U.S. Gov't : United States</p><p>issue_number: 4</p><p>ntis_number: PB2001-105740</p><p>page_range: 167-172</p><p>primary_author: Poullier, Jean P</p><p>title: Administrative costs in selected industrialized countries.</p><p>volume: 13</p><p>year_period: 1992 Summer</p>]]></description></item><item><title>Contemplating home health PPS: current patterns of Medicare service use.</title><pubDate>Mon, 04 Nov 2019 02:27:14 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191339</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191339</guid><description><![CDATA[<p>abstract: Implementing a per-episode prospective payment system (PPS) for home health services is one option for Medicare policy makers facing rapid increases in service use and expenditures. Analysis of data on recent episodes of Medicare home health care identified systematic differences in service patterns across provider types; these indicate potential differences in the capacity of agencies of different types to adjust to PPS. The second phase of a national demonstration, which is about to be implemented, will provide information on the extent to which the agency practices that generate much of the observed variation (such as the number of visits provided per episode) are susceptible to management decisions; and whether managers can and do respond to the incentives of per-episode prospective payment.</p><p>authors: Schmitz, Robert J</p><p>issue_mesh: Episode of Care : Data Collection : Evaluation Studies : Health Expenditures/statistics &#x26; numerical data : Health Services Research : Home Care Services/economics/statistics &#x26; numerical data/utilization : Medicare/economics/statistics &#x26; numerical data/utilization : Multivariate Analysis : Prospective Payment System/trends : Regression Analysis : Research Design : United States</p><p>issue_number: 1</p><p>ntis_number: PB2001-105546</p><p>page_range: 109-130</p><p>primary_author: Goldberg, Henry B</p><p>title: Contemplating home health PPS: current patterns of Medicare service use.</p><p>volume: 16</p><p>year_period: 1994 Fall</p>]]></description></item><item><title>An evaluation of pediatric-modified diagnosis-related groups.</title><pubDate>Mon, 04 Nov 2019 02:27:14 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191299</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191299</guid><description><![CDATA[<p>abstract: Pediatric-modified diagnosis-related groups (PM-DRGs) were designed to describe more accurately than DRGs differences in severity of illness and charges across pediatric patients. We report on an evaluation of PM-DRGs for use in prospective payment systems (PPSs). Data on pediatric discharges (i.e., patients 17 years of age or under) from 5 States and a national sample of 43 hospitals were used. PM-DRGs explained substantially more variation in resource use at the discharge level and hospital level. PM-DRGs improved classification of neonatal discharges by concentrating them into fewer categories and measuring birth weight more precisely.</p><p>authors: Schwartz, Rachel M</p><p>issue_mesh: Child : Diagnosis-Related Groups/classification/economics : Health Services Research : Hospitals, Pediatric/economics/statistics &#x26; numerical data/utilization : Human : Infant, Newborn : Intensive Care Units, Neonatal/economics/statistics &#x26; numerical data/utilization : Intensive Care Units, Pediatric/economics/statistics &#x26; numerical data/utilization : Least-Squares Analysis : Medicare Part A/statistics &#x26; numerical data : Patient Discharge/statistics &#x26; numerical data : Pediatrics/classification/economics : Prospective Payment System/statistics &#x26; numerical data : Respiration, Artificial/economics : Severity of Illness Index : Support, U.S. Gov't, Non-P.H.S. : United States</p><p>issue_number: 2</p><p>ntis_number: PB95-123469</p><p>page_range: 51-70</p><p>primary_author: Payne, Susan M</p><p>title: An evaluation of pediatric-modified diagnosis-related groups.</p><p>volume: 15</p><p>year_period: 1993 Winter</p>]]></description></item><item><title>National health expenditures projections through 2030.</title><pubDate>Mon, 04 Nov 2019 02:27:14 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191237</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191237</guid><description><![CDATA[<p>abstract: If current laws and practices continue, health expenditures in the United States will reach $1.7 trillion by the year 2000, an amount equal to 18.1 percent of the Nation's gross domestic product (GDP). By the year 2030, as America's baby boomers enter their seventies and eighties, health spending will top $16 trillion, or 32 percent of GDP. The projections presented here incorporate the assumptions and conclusions of the Medicare trustees in their 1992 report to Congress on the status of Medicare, and the 1992 President's budget estimates of Medicaid outlays.</p><p>authors: McKusick, David R; Waldo, Daniel R</p><p>issue_mesh: Forecasting : Actuarial Analysis : Aged : Data Collection : Demography : Health Expenditures/statistics &#x26; numerical data/trends : Human : Insurance, Medigap/economics/statistics &#x26; numerical data : Medicaid/economics/statistics &#x26; numerical data : Medicare/economics/statistics &#x26; numerical data : Models, Statistical : United States</p><p>issue_number: 1</p><p>ntis_number: PB95-123279</p><p>page_range: 1-30</p><p>primary_author: Burner, Sally T</p><p>title: National health expenditures projections through 2030.</p><p>volume: 14</p><p>year_period: 1992 Fall</p>]]></description></item><item><title>An update on physician practice cost shares.</title><pubDate>Mon, 04 Nov 2019 02:27:14 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191269</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191269</guid><description><![CDATA[<p>abstract: The 1988 physicians' practice costs and income survey (PPCIS) collected detailed costs, revenues, and incomes data for a sample of 3,086 physicians. These data are utilized to update the Health Care Financing Administration (HCFA) cost shares used in calculating the Medicare economic index (MEI) and the geographic practice cost index (GPCI). Cost shares were calculated for the national sample, for 16 specialty groupings, for urban and rural areas, and for 9 census divisions. Although statistical tests reveal that cost shares differ across specialties and geographic areas, sensitivity analysis shows that these differences are small enough to have trivial effects in computing the MEI and GPCI. These results may inform policymakers on one aspect of the larger issue of whether physician payments should vary by geographic location or specialty.</p><p>authors: Cromwell, Jerry L; Rosenbach, Margo L</p><p>issue_mesh: Analysis of Variance : Costs and Cost Analysis/statistics &#x26; numerical data : Data Collection : Fee Schedules/classification : Geography : Income/statistics &#x26; numerical data : Medicare Part B/economics : Physicians/classification/economics : Professional Practice Location/economics : Specialties, Medical/economics/statistics &#x26; numerical data : Support, U.S. Gov't, Non-P.H.S. : United States</p><p>issue_number: 3</p><p>ntis_number: PB95-111274</p><p>page_range: 119-137</p><p>primary_author: Dayhoff, Debra A</p><p>title: An update on physician practice cost shares.</p><p>volume: 14</p><p>year_period: 1993 Spring</p>]]></description></item><item><title>Health care indicators</title><pubDate>Mon, 04 Nov 2019 02:27:14 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191331</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191331</guid><description><![CDATA[<p>abstract: This regular feature of the journal includes a discussion of each of the following four topics: community hospital statistics; employment, hours, and earnings in the private health sector; health care prices; and national economic indicators. These statistics are valuable in their own right for understanding the relationship between the health care sector and the overall economy. In addition, they allow us to anticipate the direction and magnitude of health care cost changes prior to the availability of more comprehensive data.</p><p>authors: Maple, Brenda T; Sensenig, Arthur L</p><p>issue_mesh: Data Collection : Employment/statistics &#x26; numerical data/trends : Health Care Sector/statistics &#x26; numerical data : Health Expenditures/statistics &#x26; numerical data/trends : Health Personnel/economics : Hospitals, Community/statistics &#x26; numerical data/trends : Length of Stay/statistics &#x26; numerical data/trends : Salaries and Fringe Benefits/statistics &#x26; numerical data/trends : United States</p><p>issue_number: 4</p><p>ntis_number: PB99-106437</p><p>page_range: 165-195</p><p>primary_author: Donham, Carolyn S</p><p>title: Health care indicators</p><p>volume: 15</p><p>year_period: 1994 Summer</p>]]></description></item><item><title>Medicaid case management: Kentucky's Patient Access and Care Program.</title><pubDate>Mon, 04 Nov 2019 02:27:14 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191291</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191291</guid><description><![CDATA[<p>abstract: Since 1981, States have been experimenting with Medicaid managed care programs to improve access and continuity of care and to contain costs by reducing inappropriate and unnecessary utilization. To determine the impact of primary care case management (PCCM) on utilization, the authors examine data from the Kentucky Patient Access and Care program (KenPAC). Using monthly utilization data from 1984 to 1989 and an interrupted time-series research design, the authors find that PCCM reduces the use of independent laboratory, physician, emergency department, and outpatient hospital services. PCCM does not appear to affect utilization of inpatient hospital services or prescription drugs.</p><p>authors: Gengler, Daniel J</p><p>issue_mesh: Health Services Accessibility/statistics &#x26; numerical data : Health Services Research : Hospitals/utilization : Kentucky : Longitudinal Studies : Managed Care Programs/economics/statistics &#x26; numerical data/utilization : Medicaid/organization &#x26; administration/statistics &#x26; numerical data : Models, Statistical : Primary Health Care/utilization : Regression Analysis : Reproducibility of Results : State Health Plans/economics/statistics &#x26; numerical data : United States : Utilization Review</p><p>issue_number: 1</p><p>ntis_number: PB95-123493</p><p>page_range: 55-69</p><p>primary_author: Miller, Mark E</p><p>title: Medicaid case management: Kentucky's Patient Access and Care Program.</p><p>volume: 15</p><p>year_period: 1993 Fall</p>]]></description></item><item><title>Physician reaction to price changes: an episode-of-care analysis.</title><pubDate>Mon, 04 Nov 2019 02:27:14 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191349</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191349</guid><description><![CDATA[<p>abstract: Physicians may respond to fee reductions in a variety of ways. This episode-of-care analysis examines the impact of surgical fee reductions (mandated by the Omnibus Budget Reconciliation Acts [OBRAs] of 1986-87) on the overall pattern and cost of health care services provided in association with the surgical procedure itself. The study focuses on six procedure groups: cataract extractions; total hip replacement; total knee replacement; coronary artery bypass graft (CABG) surgery; upper gastrointestinal (GI) endoscopy; and prostatectomy. Only two of these procedures give significant evidence for the existence of a service volume offset to the fee reductions.</p><p>authors: Mitchell, Janet B</p><p>issue_mesh: Episode of Care : Data Collection : Fee Schedules/legislation &#x26; jurisprudence : Health Services Research : Human : Medicare Part B/legislation &#x26; jurisprudence/statistics &#x26; numerical data : Patterns/economics/statistics &#x26; numerical data : Physician's Practice : Regression Analysis : Relative Value Scales : Specialties, Surgical/economics : Support, U.S. Gov't, Non-P.H.S. : Surgical Procedures, Operative/economics/utilization : United States</p><p>issue_number: 2</p><p>ntis_number: PB99-106486</p><p>page_range: 65-83</p><p>primary_author: Lee, A James</p><p>title: Physician reaction to price changes: an episode-of-care analysis.</p><p>volume: 16</p><p>year_period: 1994 Winter</p>]]></description></item><item><title>Medicare home health: a description of total episodes of care.</title><pubDate>Mon, 04 Nov 2019 02:27:14 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191279</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191279</guid><description><![CDATA[<p>abstract: The purpose of this study was to present descriptive information on the characteristics of 2,873 Medicare home health clients, to quantify systematically their patterns of service utilization and allowed charges during a total episode of care, and to clarify the bivariate associations between client characteristics and utilization. The model client was female, 75-84 years of age, living with a spouse, and frail based on a variety of indicators. The mean total episode was approximately 23 visits, with allowed charges of $1,238 (1986 dollars). Specific subgroups of clients, defined by their morbidities and frailties, used identifiable clusters of services. Implications for case-mix models and implications for capitation payments under health care reform are discussed.</p><p>authors: Cheh, Valerie A; Goldberg, Henry B; Williams, Judith</p><p>issue_mesh: Episode of Care : Aged : Data Collection : Demography : Diagnosis-Related Groups/statistics &#x26; numerical data : Fees and Charges/statistics &#x26; numerical data : Female : Home Care Services/economics/utilization : Human : Medicare/statistics &#x26; numerical data/utilization : Multivariate Analysis : Support, U.S. Gov't, Non-P.H.S. : United States</p><p>issue_number: 4</p><p>ntis_number: PB95-123485</p><p>page_range: 59-74</p><p>primary_author: Branch, Laurence G</p><p>title: Medicare home health: a description of total episodes of care.</p><p>volume: 14</p><p>year_period: 1993 Summer</p>]]></description></item><item><title>The cost effectiveness of prenatal care.</title><pubDate>Mon, 04 Nov 2019 02:27:14 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191321</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191321</guid><description><![CDATA[<p>abstract: This study uses hospital records for 7,000 births in McLennan County, Texas, during the period June 1987-July 1989 to examine the association between prenatal care and birth outcome and the implications for hospital costs of newborn infants. After controlling for a variety of maternal and birth factors, a significant relationship between prenatal care and birth outcome remained. Females who failed to receive prenatal care were almost three times as likely to have a low-birth-weight infant (weighing less than 2,500 grams) than females who did. Using an ordinary least squares (OLS) estimating equation (R2 = .24), the net expected hospital cost savings for females who received prenatal care was over $1,000.</p><p>authors: N/A</p><p>issue_mesh: Causality : Comparative Study : Cost-Benefit Analysis/statistics &#x26; numerical data : Data Collection : Ethnic Groups : Female : Health Services Research : Hospital Charges/statistics &#x26; numerical data : Hospital Costs/statistics &#x26; numerical data : Hospitalization/economics : Human : Infant, Low Birth Weight : Infant, Newborn : Intensive Care Units, Neonatal/economics : Least-Squares Analysis : Marital Status : Pregnancy : Pregnancy Outcome/economics : Prenatal Care/economics/statistics &#x26; numerical data/utilization : Texas/epidemiology</p><p>issue_number: 4</p><p>ntis_number: PB99-106437</p><p>page_range: 21-32</p><p>primary_author: Henderson, James W</p><p>title: The cost effectiveness of prenatal care.</p><p>volume: 15</p><p>year_period: 1994 Summer</p>]]></description></item><item><title>End stage renal disease.</title><pubDate>Mon, 04 Nov 2019 02:27:14 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191229</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191229</guid><description><![CDATA[<p>ntis_number: PB99-106460</p><p>page_range: 199-205</p><p>primary_author: Greer, Joel W</p><p>title: End stage renal disease.</p><p>volume: Supp.</p><p>year_period: 1992 Supp.</p>]]></description></item><item><title>State Medicaid health maintenance organization policies and special-needs children.</title><pubDate>Mon, 04 Nov 2019 02:27:14 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191289</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191289</guid><description><![CDATA[<p>abstract: Little research has been done to ascertain what enrollment in a health maintenance organization (HMO) may mean for the care of Medicaid recipients who regularly require specialty health services. This article presents the results of a survey of all State Medicaid agencies regarding their policies for enrolling and serving special-needs children in HMOs. The survey revealed that many States have implemented one or more strategies to protect special-needs Medicaid recipients enrolled in HMOs. The survey results suggest, however, that such strategies are too limited in scope to ensure appropriate access to specialty services for all children with special health needs.</p><p>authors: Newacheck, Paul W; Wicks, Lori B</p><p>issue_mesh: Child : Child Health Services/economics : Data Collection : Disabled Persons/statistics &#x26; numerical data : Health Maintenance Organizations/economics/utilization : Health Services Research : Human : Medicaid/organization &#x26; administration/statistics &#x26; numerical data/utilization : Organizational Policy : Risk : State Health Plans/organization &#x26; administration : Support, U.S. Gov't, P.H.S. : United States</p><p>issue_number: 1</p><p>ntis_number: PB95-123493</p><p>page_range: 25-37</p><p>primary_author: Fox, Harriette B</p><p>title: State Medicaid health maintenance organization policies and special-needs children.</p><p>volume: 15</p><p>year_period: 1993 Fall</p>]]></description></item><item><title>Comparison of rural and urban skilled nursing facility benefit use.</title><pubDate>Mon, 04 Nov 2019 02:27:14 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191277</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191277</guid><description><![CDATA[<p>abstract: In this article, differences in use of Medicare's skilled nursing facility (SNF) benefit in urban and rural areas are examined. Using SNF benefit bills from 1987, the study finds that there appear to be systematic differences by residential location both in the level of use of the benefit and in whether enrollees are admitted to nursing homes and hospital swing beds. Rural Medicare enrollees use the SNF benefit at a rate that is 15 percent higher than the rate for urban enrollees. Furthermore, the swing-bed program appears to play a critical role in providing access to post-acute care for the rural elderly. In rural areas, almost 29 percent of all SNF benefit admissions are to swing beds.</p><p>authors: N/A</p><p>issue_mesh: Aged : Bed Conversion/statistics &#x26; numerical data : Comparative Study : Data Collection : Demography : Diagnosis-Related Groups/statistics &#x26; numerical data : Female : Geography : Human : Male : Medicare/statistics &#x26; numerical data/utilization : Patient Admission/statistics &#x26; numerical data : Rural Health/statistics &#x26; numerical data : Skilled Nursing Facilities/economics/utilization : Support, U.S. Gov't, Non-P.H.S. : United States : Urban Health/statistics &#x26; numerical data : Utilization Review/statistics &#x26; numerical data</p><p>issue_number: 4</p><p>ntis_number: PB95-123485</p><p>page_range: 25-37</p><p>primary_author: Dubay, Lisa C</p><p>title: Comparison of rural and urban skilled nursing facility benefit use.</p><p>volume: 14</p><p>year_period: 1993 Summer</p>]]></description></item><item><title>Medicare and Medicaid managed care: issues and evidence.</title><pubDate>Mon, 04 Nov 2019 02:27:14 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191287</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191287</guid><description><![CDATA[<p>authors: N/A</p><p>issue_mesh: Managed Care Programs : Medicaid : Medicare : United States</p><p>issue_number: 1</p><p>ntis_number: PB95-123493</p><p>page_range: 1-5</p><p>primary_author: Hadley, James P</p><p>title: Medicare and Medicaid managed care: issues and evidence.</p><p>volume: 15</p><p>year_period: 1993 Fall</p>]]></description></item><item><title>Home health and skilled nursing facility use: 1982-90.</title><pubDate>Mon, 04 Nov 2019 02:27:14 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191341</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191341</guid><description><![CDATA[<p>abstract: In this article, analyses are made of home health and skilled nursing facility (SNF) use for the period 1982-90 using Medicare records linked to data on community and institutional residents from the National Long-Term Care Surveys (NLTCSs) of 1982, 1984, and 1989. The combined survey and administrative data analyses are performed to ascertain how the chronic health and functional characteristics of community and institutional residents using Medicare-reimbursed services changed during the period. During this period, changes had been made in the Medicare system that affected the use of services for persons with specific health and functional problems.</p><p>authors: Stallard, Eric; Woodbury, Max A</p><p>issue_mesh: Activities of Daily Living : Aged : Chronic Disease : Data Collection : Health Care Costs/statistics &#x26; numerical data : Health Services Research : Health Status Indicators : Home Care Services/economics/statistics &#x26; numerical data/trends/utilization : Human : Longitudinal Studies : Medicare/economics/statistics &#x26; numerical data/utilization : Models, Statistical : Multivariate Analysis : Research Design : Skilled Nursing Facilities/economics/statistics &#x26; numerical data/trends/utilization : Support, U.S. Gov't, Non-P.H.S. : Support, U.S. Gov't, P.H.S. : United States</p><p>issue_number: 1</p><p>ntis_number: PB2001-105546</p><p>page_range: 155-186</p><p>primary_author: Manton, Kenneth G</p><p>title: Home health and skilled nursing facility use: 1982-90.</p><p>volume: 16</p><p>year_period: 1994 Fall</p>]]></description></item><item><title>Excluded facility financial status and options for payment system modification.</title><pubDate>Mon, 04 Nov 2019 02:27:14 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191297</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191297</guid><description><![CDATA[<p>abstract: Psychiatric, rehabilitation, long-term care, and children's facilities have remained under the reimbursement system established under the Tax Equity and Fiscal Responsibility Act (TEFRA) of 1982 (Public Law 97-248). The number of TEFRA facilities and discharges has been increasing while their average profit rates have been steadily declining. Modifying TEFRA would require either rebasing the target amount or adjusting cost sharing for facilities exceeding their cost target. Based on our simulations of alternative payment systems, we recommend rebasing facilities' target amounts using a 50/50 blend of own costs and national average costs. Cost sharing above the target amount could be increased to include more government sharing of losses.</p><p>authors: Cromwell, Jerry L; McGuire, Thomas P</p><p>issue_mesh: Tax Equity and Fiscal Responsibility Act : Cost Sharing/methods : Geography : Health Services Research : Hospital Costs/statistics &#x26; numerical data : Hospital Units/economics : Hospitals, Pediatric/economics : Hospitals, Psychiatric/economics : Hospitals, Special/economics/legislation &#x26; jurisprudence/statistics &#x26; numerical data : Income/statistics &#x26; numerical data : Insurance, Health, Reimbursement/statistics &#x26; numerical data : Medicare Part A/legislation &#x26; jurisprudence/statistics &#x26; numerical data : Outliers, DRG/economics : Ownership/economics : Rehabilitation Centers/economics : Residential Facilities/economics : Substance Abuse Treatment Centers/economics : Support, U.S. Gov't, Non-P.H.S. : United States</p><p>issue_number: 2</p><p>ntis_number: PB95-123469</p><p>page_range: 7-30</p><p>primary_author: Schneider, John E</p><p>title: Excluded facility financial status and options for payment system modification.</p><p>volume: 15</p><p>year_period: 1993 Winter</p>]]></description></item><item><title>Pharmaceutical spending and German reunification: parity comes quickly to Berlin.</title><pubDate>Mon, 04 Nov 2019 02:27:13 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191317</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191317</guid><description><![CDATA[<p>abstract: As the Berlin Wall fell and the population of the Federal Republic of Germany (FRG, West Germany) swelled by 25 percent with the addition of the former German Democratic Republic (GDR, East Germany), the health care system struggled to keep pace. This article examines drug outlays by the statutory sickness funds during the first 2 years of unified operations. It shows that providing equivalent coverage quickly led to equal rates of pharmaceutical consumption nationwide, while in Berlin the former East outdistanced the West by a considerable margin.</p><p>authors: N/A</p><p>issue_mesh: Drug Costs/trends : Germany, East : Germany, West : Health Expenditures/statistics &#x26; numerical data/trends : Health Services Research : Human : Infant, Newborn : Insurance, Pharmaceutical Services/statistics &#x26; numerical data/utilization : National Health Programs/economics : Political Systems : Socioeconomic Factors : State Medicine/economics : Support, Non-U.S. Gov't : Support, U.S. Gov't, Non-P.H.S.</p><p>issue_number: 3</p><p>ntis_number: PB95-123477</p><p>page_range: 141-156</p><p>primary_author: Katz, Eric M</p><p>title: Pharmaceutical spending and German reunification: parity comes quickly to Berlin.</p><p>volume: 15</p><p>year_period: 1994 Spring</p>]]></description></item><item><title>An outlier pool for Medicare HMO payments.</title><pubDate>Mon, 04 Nov 2019 02:27:13 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191239</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191239</guid><description><![CDATA[<p>abstract: Medicare pays "at-risk" health maintenance organizations a prospective capitation amount that is established by the adjusted average per capita cost (AAPCC) formula for estimating the amount enrollees would have cost had they remained in the fee-for-service sector. Because the AAPCC accounts for a very small percentage of the variation in beneficiary costs, considerable research has been devoted to improving the formula. A way to improve the explained variance is to remove the most expensive beneficiaries from the AAPCC payment system and pay for them separately. This article examines one approach to a payment system that combines the AAPCC with an outlier payment mechanism.</p><p>authors: N/A</p><p>issue_mesh: Capitation Fee/statistics &#x26; numerical data : Health Maintenance Organizations/economics : Insurance Pools/economics : Medicare/economics/organization &#x26; administration : Outliers, DRG/economics : Prospective Payment System/economics : Rate Setting and Review : Risk : United States</p><p>issue_number: 1</p><p>ntis_number: PB95-123279</p><p>page_range: 59-63</p><p>primary_author: Beebe, James C</p><p>title: An outlier pool for Medicare HMO payments.</p><p>volume: 14</p><p>year_period: 1992 Fall</p>]]></description></item><item><title>Health care indicators</title><pubDate>Mon, 04 Nov 2019 02:27:13 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191307</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191307</guid><description><![CDATA[<p>authors: Maple, Brenda T; Sivarajan, Lekha</p><p>issue_mesh: Budgets/legislation &#x26; jurisprudence : Deductibles and Coinsurance/legislation &#x26; jurisprudence : Economics, Hospital/legislation &#x26; jurisprudence : Education, Medical, Graduate/economics : Health Maintenance Organizations/economics/legislation &#x26; jurisprudence : Insurance, Health, Reimbursement/legislation &#x26; jurisprudence : Medicaid/legislation &#x26; jurisprudence : Medicare Part A/legislation &#x26; jurisprudence : Medicare Part B/legislation &#x26; jurisprudence : Medicare/legislation &#x26; jurisprudence : United States</p><p>issue_number: 2</p><p>ntis_number: PB95-123469</p><p>page_range: 203-232</p><p>primary_author: Donham, Carolyn S</p><p>title: Health care indicators</p><p>volume: 15</p><p>year_period: 1993 Winter</p>]]></description></item><item><title>Medicaid policies for HIV-related prescription drugs.</title><pubDate>Mon, 04 Nov 2019 02:27:13 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191311</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191311</guid><description><![CDATA[<p>abstract: As State Medicaid programs become increasingly important sources of payment for acquired immunodeficiency syndrome (AIDS)-related care, and drug regimens the major weapons available to fight human immunodeficiency virus (HIV)-related illnesses, Medicaid drug policies will have a substantial impact. State Medicaid programs were surveyed to identify policies on a range of prescription drug policies affecting these recipients. All Medicaid programs provide prescription drug benefits to all categorically needy recipients, and about three-fourths of the States provide these benefits to medically needy recipients. However, utilization limits, copayments, and off-label-use and prior-authorization policies in many States weaken the drug benefit available.</p><p>authors: Smith, Scott R</p><p>issue_mesh: Comparative Study : Cost Sharing : Data Collection : Drug Costs : Eligibility Determination : Health Policy/economics : HIV Infections/drug therapy/economics : Human : Insurance, Pharmaceutical Services/economics/statistics &#x26; numerical data : Medicaid/economics/statistics &#x26; numerical data : Prescriptions, Drug/economics : State Health Plans/economics : Support, U.S. Gov't, P.H.S. : United States</p><p>issue_number: 3</p><p>ntis_number: PB95-123477</p><p>page_range: 43-61</p><p>primary_author: Buchanan, Robert J</p><p>title: Medicaid policies for HIV-related prescription drugs.</p><p>volume: 15</p><p>year_period: 1994 Spring</p>]]></description></item><item><title>Health care of vulnerable populations covered by Medicare and Medicaid.</title><pubDate>Mon, 04 Nov 2019 02:27:13 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191319</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191319</guid><description><![CDATA[<p>abstract: This overview discusses articles published in this issue of the Health Care Financing Review, entitled "Health care of vulnerable populations." Articles cover the following vulnerable population subgroups: pregnant women and children, persons with AIDS, the disabled, and the elderly. Issues covered in this collection include: expenditures, demographic factors, Medicaid and Medicare policy, service use, medical procedures, and data collection.</p><p>authors: N/A</p><p>issue_mesh: Health Services Needs and Demand : Medicaid : Medicare : United States</p><p>issue_number: 4</p><p>ntis_number: PB99-106437</p><p>page_range: 1-5</p><p>primary_author: Hirsch, Marilyn B</p><p>title: Health care of vulnerable populations covered by Medicare and Medicaid.</p><p>volume: 15</p><p>year_period: 1994 Summer</p>]]></description></item><item><title>Who cares what it costs to dispense a Medicaid prescription?</title><pubDate>Mon, 04 Nov 2019 02:27:13 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191309</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191309</guid><description><![CDATA[<p>abstract: Results of a 1992 Medicaid cost-of-dispensing study among North Carolina pharmacies are presented. The estimated statewide weighted average cost incurred by pharmacies to dispense a prescription was $5.37 in 1991. The variation in dispensing costs found among pharmacies of various sizes, organizational types, and locations is identified. Higher average dispensing costs were reported for large chain pharmacies and those pharmacies in urban areas. Considering the potential for expanded prescription drug benefits under a reformed health care system, the implications of the study's findings for pharmacy payment policy are discussed.</p><p>authors: Johnston, William P; Kilpatrick, Kerry E; Norwood, G Joseph</p><p>issue_mesh: Data Collection : Health Care Costs/statistics &#x26; numerical data : Insurance, Pharmaceutical Services/economics/statistics &#x26; numerical data : Medicaid/economics/statistics &#x26; numerical data : Models, Economic : North Carolina : Pharmacies/classification/economics : Prescription Fees/statistics &#x26; numerical data : Prescriptions, Drug/economics : Regression Analysis : Support, Non-U.S. Gov't : United States</p><p>issue_number: 3</p><p>ntis_number: PB95-123477</p><p>page_range: 9-24</p><p>primary_author: Lamphere-Thorpe, Joe A</p><p>title: Who cares what it costs to dispense a Medicaid prescription?</p><p>volume: 15</p><p>year_period: 1994 Spring</p>]]></description></item><item><title>Long-term care: emerging trends.</title><pubDate>Mon, 04 Nov 2019 02:27:13 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191275</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191275</guid><description><![CDATA[<p>authors: Saunders, William D</p><p>issue_mesh: Long-Term Care/economics : Medicaid/statistics &#x26; numerical data : Medicare/statistics &#x26; numerical data : United States</p><p>issue_number: 4</p><p>ntis_number: PB95-123485</p><p>page_range: 1-4</p><p>primary_author: Miller, Nancy A</p><p>title: Long-term care: emerging trends.</p><p>volume: 14</p><p>year_period: 1993 Summer</p>]]></description></item><item><title>Trends in Medicaid nursing home reimbursement: 1978-89.</title><pubDate>Mon, 04 Nov 2019 02:27:13 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191282</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191282</guid><description><![CDATA[<p>abstract: Medicaid nursing home reimbursement is of concern because of implications for nursing home expenditures. This article presents data on State Medicaid nursing home reimbursement methods, ratesetting methods, and average per diem rates, refining earlier data and updating through 1989. A trend in the early 1980s toward adopting prospective systems played out by the end of the decade. There were trends, however, toward casemix methods, which may increase access for high-need patients, and toward cost-center limits on nursing, which may provide incentives to lower quality care. Analysis supports previous findings that prospective systems allow greater control over increases in rates.</p><p>authors: Grant, Leslie; Harrington, Charlene; Luehrs, John; Preston, Steve</p><p>issue_mesh: Data Collection : Medicaid/organization &#x26; administration/trends : Nursing Homes/economics/trends : Rate Setting and Review/methods/trends : Reimbursement Mechanisms/classification/trends : State Health Plans/economics/trends : Support, U.S. Gov't, P.H.S. : United States</p><p>issue_number: 4</p><p>ntis_number: PB95-123485</p><p>page_range: 111-132</p><p>primary_author: Swan, James H</p><p>title: Trends in Medicaid nursing home reimbursement: 1978-89.</p><p>volume: 14</p><p>year_period: 1993 Summer</p>]]></description></item><item><title>Assessing the FY 1989 change in Medicare PPS outlier policy.</title><pubDate>Mon, 04 Nov 2019 02:27:13 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191253</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191253</guid><description><![CDATA[<p>abstract: In fiscal year (FY) 1989, Medicare changed its rules for paying for extremely long or expensive hospital stays called "outliers." We compared outlier payments in FYs 1989 and 1988, after adjusting for other simultaneous policy changes. We found that the new policy succeeded in targeting more outlier payments to the most expensive cases and to the hospitals suffering larger prospective payment system (PPS) losses and in reducing hospital financial risk. Using time-series analyses, we show that the policy change had no measurable effect on the timing of discharges or on the concentration of expensive cases in urban government-owned hospitals.</p><p>authors: Farley, Donna O</p><p>issue_mesh: Comparative Study : Data Collection : Economics, Hospital/trends : Hospitals, Public/economics : Hospitals, Urban/economics : Least-Squares Analysis : Medicare Part A/economics/statistics &#x26; numerical data : Organizational Policy : Outliers, DRG/economics/statistics &#x26; numerical data : Program Evaluation : Prospective Payment System/economics/standards : Support, Non-U.S. Gov't : Support, U.S. Gov't, Non-P.H.S. : United States</p><p>issue_number: 2</p><p>ntis_number: PB2001-105739</p><p>page_range: 69-82</p><p>primary_author: Carter, Grace M</p><p>title: Assessing the FY 1989 change in Medicare PPS outlier policy.</p><p>volume: 14</p><p>year_period: 1992 Winter</p>]]></description></item><item><title>Medicare program expenditures.</title><pubDate>Mon, 04 Nov 2019 02:27:13 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191223</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191223</guid><description><![CDATA[<p>ntis_number: PB99-106460</p><p>page_range: 23-54</p><p>primary_author: Helbing, Charles</p><p>title: Medicare program expenditures.</p><p>volume: Supp.</p><p>year_period: 1992 Supp.</p>]]></description></item><item><title>Nursing home resident assessment and case-mix classification: cross-national perspectives.</title><pubDate>Mon, 04 Nov 2019 02:27:13 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191217</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191217</guid><description><![CDATA[<p>abstract: Two broadly applied systems in the United States, the National Resident Assessment Instrument/Minimum Data Set and the Resource Utilization Groups, have provided new insight into the quality, delivery, and financing of nursing home care. In this article, the authors describe research efforts in eight other nations to translate, validate, and use one or both systems to understand their own long-term care systems. This consortium of studies, using common instruments, provides potential cross-national analyses that capitalize on differences in practice patterns and system designs to address critical policy issues.</p><p>authors: Fries, Brant E</p><p>issue_mesh: Activities of Daily Living/classification : Aged : Aged, 80 and over : Asia : Australia : Comparative Study : Data Collection/standards : Diagnosis-Related Groups/classification/statistics &#x26; numerical data : Europe : Forms and Records Control/methods : Frail Elderly/statistics &#x26; numerical data : Geriatric Assessment/classification : Health Resources/utilization : Homes for the Aged/classification/utilization : Human : Inpatients/classification : Long-Term Care/classification : Nursing Homes/classification/utilization : United States : United States Health Care Financing Administration</p><p>issue_number: 4</p><p>ntis_number: PB2001-105740</p><p>page_range: 135-155</p><p>primary_author: Clauser, Steven B</p><p>title: Nursing home resident assessment and case-mix classification: cross-national perspectives.</p><p>volume: 13</p><p>year_period: 1992 Summer</p>]]></description></item><item><title>Stability of frailty in the social/health maintenance organization.</title><pubDate>Mon, 04 Nov 2019 02:27:13 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191327</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191327</guid><description><![CDATA[<p>abstract: Although many long-term care (LTC) programs assume that the disabilities of their frail elderly participants are stable in nature, there has been suggestive evidence to the contrary. This study tests stability of disability among social/health maintenance organization (S/HMO) members who were judged eligible for admission into a nursing home. Identified persons were reassessed quarterly. By the end of 1 year, less than 50 percent were still considered to be nursing home eligible. Logit analysis revealed an increased likelihood of instability for persons who were newly identified as functionally disabled after hospitalization. Policy implications for capitated managed-care programs for the elderly are discussed.</p><p>authors: Capitman, John A; Leutz, Walter; Ritter, Grant A</p><p>issue_mesh: Geriatric Assessment : Risk Assessment : Aged : Data Collection : Eligibility Determination : Evaluation Studies : Frail Elderly/statistics &#x26; numerical data : Health Maintenance Organizations/statistics &#x26; numerical data/utilization : Health Services Research : Human : Insurance, Health, Reimbursement : Medicare/statistics &#x26; numerical data/utilization : Nursing Homes/utilization : Probability : Progressive Patient Care : Support, U.S. Gov't, Non-P.H.S. : United States</p><p>issue_number: 4</p><p>ntis_number: PB99-106437</p><p>page_range: 105-116</p><p>primary_author: Hallfors, Denise</p><p>title: Stability of frailty in the social/health maintenance organization.</p><p>volume: 15</p><p>year_period: 1994 Summer</p>]]></description></item><item><title>Contributions of case mix and intensity change to hospital cost increases.</title><pubDate>Mon, 04 Nov 2019 02:27:13 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191259</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191259</guid><description><![CDATA[<p>abstract: The 28-percent change in average Medicare inpatient cost per case between 1984 and 1987 is decomposed into three components: input price inflation, changes in average cost within diagnosis-related groups (DRGs) (intensity), and changes in the distribution of cases across DRGs (case mix). We estimate the contributions of technology diffusion and outpatient shifts to within-DRG and across-DRG cost changes. We also use California data to estimate the contribution of changes in the quantity of services provided during a stay. The factors examined account for approximately 80 percent of the real increase in average cost per case.</p><p>authors: Kominski, Gerald F</p><p>issue_mesh: California : Cost Allocation/statistics &#x26; numerical data/trends : Data Collection : Diagnosis-Related Groups/classification/economics : Diffusion of Innovation : Economics, Hospital/statistics &#x26; numerical data : Medicare/economics/utilization : Outpatient Clinics, Hospital/economics/utilization : Prospective Payment System/economics : Support, Non-U.S. Gov't : Support, U.S. Gov't, Non-P.H.S. : Technology, Medical/economics : United States</p><p>issue_number: 2</p><p>ntis_number: PB2001-105739</p><p>page_range: 151-163</p><p>primary_author: Bradley, Thomas B</p><p>title: Contributions of case mix and intensity change to hospital cost increases.</p><p>volume: 14</p><p>year_period: 1992 Winter</p>]]></description></item><item><title>National health expenditures, 1991.</title><pubDate>Mon, 04 Nov 2019 02:27:13 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191249</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191249</guid><description><![CDATA[<p>abstract: Spending for health care rose to $751.8 billion in 1991, an increase of 11.4 percent from the 1990 level. National health expenditures as a share of gross domestic product increased to 13.2 percent, up from 12.2 percent in 1990. The health care sector exhibited strong growth, despite slow growth in the overall economy. This combination resulted in the largest increase in the share of the Nation's output consumed by health care in the past three decades. In this article, the authors present estimates of health spending in the United States for 1991. The authors also examine reasons for the unusually large growth in Medicaid expenditures and highlight recent trends in the hospital sector.</p><p>authors: Cowan, Cathy A; Lazenby, Helen C; Levit, Katharine R</p><p>issue_mesh: Data Collection : Economics, Hospital/statistics &#x26; numerical data/trends : Financing, Personal/statistics &#x26; numerical data/trends : Health Expenditures/statistics &#x26; numerical data/trends : Insurance, Health/economics/statistics &#x26; numerical data/trends : Medicaid/economics/statistics &#x26; numerical data/trends : Medicare/economics/statistics &#x26; numerical data/trends : Nursing Homes/economics : Personal Health Services/economics : Physicians/economics : United States</p><p>issue_number: 2</p><p>ntis_number: PB2001-105739</p><p>page_range: 1-30</p><p>primary_author: Letsch, Suzanne W</p><p>title: National health expenditures, 1991.</p><p>volume: 14</p><p>year_period: 1992 Winter</p>]]></description></item><item><title>Containing use and expenditures in publicly insured long-term care programs.</title><pubDate>Mon, 04 Nov 2019 02:27:12 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191285</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191285</guid><description><![CDATA[<p>abstract: British Columbia and Manitoba have the most developed and comprehensive publicly financed long-term care (LTC) programs in North America. For U.S. policymakers, these programs are large-scale natural experiments with public LTC insurance. During the 1980s, both provinces successfully contained the growth of public expenditures on nursing homes, and one province successfully contained the growth of public expenditures on home support services, adjusting for population growth. Because provincial cost-control methods are similar to those that some States already use, it is likely that managers could contain the growth of public expenditures once a publicly insured U.S. LTC program was implemented. The level of public expenditure would depend partly on the level of compensation for LTC sector personnel, which is relatively low in the United States.</p><p>authors: N/A</p><p>issue_mesh: Aged : British Columbia : Cost Control/methods : Data Collection : Health Expenditures/statistics &#x26; numerical data : Home Care Services/economics/utilization : Homes for the Aged/economics/utilization : Human : Insurance, Long-Term Care/economics/utilization : Manitoba : National Health Programs/economics : Nursing Homes/economics/utilization : United States : Utilization Review/statistics &#x26; numerical data</p><p>issue_number: 4</p><p>ntis_number: PB95-123485</p><p>page_range: 181-207</p><p>primary_author: Miller, Robert H</p><p>title: Containing use and expenditures in publicly insured long-term care programs.</p><p>volume: 14</p><p>year_period: 1993 Summer</p>]]></description></item><item><title>Introducing fees for services with professional uncertainty.</title><pubDate>Mon, 04 Nov 2019 02:27:12 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191243</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191243</guid><description><![CDATA[<p>abstract: A change in payment system of general practitioners from capitation to a mix of one-half capitation and one-half fee for service in Copenhagen, Denmark, resulted in a significant overall increase in diagnostic and curative services. The rate of increase differs between services. In this article, it is assumed that the rate of increase varies with doctors' professional uncertainty relative to the services studied. Professional uncertainty is measured as the degree to which performances of a service are determined by diagnoses made. The data validate the measure given the assumption.</p><p>authors: Groenewegen, Peter P</p><p>issue_mesh: Capitation Fee : Fees, Medical : Attitude of Health Personnel : Comparative Study : Data Collection : Denmark : Diagnostic Services/economics/utilization : Family Practice/economics/statistics &#x26; numerical data : Health Services Research : Prospective Payment System : Referral and Consultation/economics : Reproducibility of Results</p><p>issue_number: 1</p><p>ntis_number: PB95-123279</p><p>page_range: 107-115</p><p>primary_author: Flierman, Henk A</p><p>title: Introducing fees for services with professional uncertainty.</p><p>volume: 14</p><p>year_period: 1992 Fall</p>]]></description></item><item><title>Measuring the relationship between income and NHEs (national health expenditures).</title><pubDate>Mon, 04 Nov 2019 02:27:12 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191245</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191245</guid><description><![CDATA[<p>abstract: This article uses recently published time series data for the Organization for Economic Cooperation and Development countries to estimate income elasticities for health care expenditures. Several different models and alternative specifications are examined to determine the sensitivity and robustness of the estimated relationships. Income is the dominant-determinant of health care spending and longrun income elasticity for health care is significantly greater than unity. This implies that health care is a luxury good, and expenditures will tend to rise with the level of national income. There is little evidence that the degree of public finance reduces the level of health care expenditures.</p><p>authors: Fheili, Mohammad; Newman, Robert J</p><p>issue_mesh: Data Collection : Europe : Health Expenditures/statistics &#x26; numerical data : Health Services Research : Income/statistics &#x26; numerical data : International Agencies/statistics &#x26; numerical data : Models, Econometric : Regression Analysis</p><p>issue_number: 1</p><p>ntis_number: PB95-123279</p><p>page_range: 133-139</p><p>primary_author: Moore, William J</p><p>title: Measuring the relationship between income and NHEs (national health expenditures).</p><p>volume: 14</p><p>year_period: 1992 Fall</p>]]></description></item><item><title>Trends in Medicaid payments and users of covered services, 1975-91.</title><pubDate>Mon, 04 Nov 2019 02:27:12 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191232</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191232</guid><description><![CDATA[<p>ntis_number: PB99-106460</p><p>page_range: 235-269</p><p>primary_author: Pine, Penelope L</p><p>title: Trends in Medicaid payments and users of covered services, 1975-91.</p><p>volume: Supp.</p><p>year_period: 1992 Supp.</p>]]></description></item><item><title>What affects rural beneficiaries use of urban and rural hospitals?</title><pubDate>Mon, 04 Nov 2019 02:27:12 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191255</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191255</guid><description><![CDATA[<p>abstract: Analysis of the Medicare provider analysis record (MEDPAR) data during fiscal years 1984 through 1989 indicates that the proportion of rural Medicare beneficiaries hospitalized in urban hospitals has remained constant during the prospective payment system (PPS). Much of the use of urban hospitals by rural beneficiaries during this period was to obtain specialized care or surgery, as suggested by the analysis, and is consistent with historical patterns of referral of rural patients. Thus, the bypassing of rural hospitals by rural beneficiaries for treatment in urban hospitals has probably not increased during PPS.</p><p>authors: N/A</p><p>issue_mesh: Catchment Area (Health)/economics/statistics &#x26; numerical data : Data Collection : Demography : Diagnosis-Related Groups/statistics &#x26; numerical data : Hospitals, Rural/economics/utilization : Hospitals, Urban/economics/utilization : Logistic Models : Medicare/statistics &#x26; numerical data/utilization : Multivariate Analysis : United States</p><p>issue_number: 2</p><p>ntis_number: PB2001-105739</p><p>page_range: 107-114</p><p>primary_author: Buczko, William</p><p>title: What affects rural beneficiaries use of urban and rural hospitals?</p><p>volume: 14</p><p>year_period: 1992 Winter</p>]]></description></item><item><title>A profile of home health users in 1992.</title><pubDate>Mon, 04 Nov 2019 02:27:12 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191335</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191335</guid><description><![CDATA[<p>abstract: Recently, the use of home health services by Medicare beneficiaries has been growing. From 1987 to 1992, the percentage of all enrollees receiving home health rose from 4.8 to 7.2 percent, while the average number of visits among users increased from 23 to 54. This article uses the 1992 Medicare Current Beneficiary Survey (MCBS) to profile home health users. In addition to providing descriptive information about who uses Medicare home health, Tobit models are estimated to determine the factors that predict home health utilization and reimbursement. Various policy options for redesigning the home health benefit are also discussed.</p><p>authors: Miller, Nancy A</p><p>issue_mesh: Activities of Daily Living : Aged : Data Collection : Evaluation Studies : Female : Health Care Costs : Health Care Reform : Health Services Research : Home Care Services/economics/statistics &#x26; numerical data/utilization : Human : Logistic Models : Medicaid : Medicare/economics/statistics &#x26; numerical data/utilization : Socioeconomic Factors : United States : Whites</p><p>issue_number: 1</p><p>ntis_number: PB2001-105546</p><p>page_range: 17-33</p><p>primary_author: Mauser, Elizabeth</p><p>title: A profile of home health users in 1992.</p><p>volume: 16</p><p>year_period: 1994 Fall</p>]]></description></item><item><title>Measuring teaching intensity with the resident-to-average daily census ratio.</title><pubDate>Mon, 04 Nov 2019 02:27:12 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191252</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191252</guid><description><![CDATA[<p>abstract: This article analyzes a change in the measure of teaching intensity when calculating Medicare's indirect medical education (IME) adjustment: It looks at the potential for replacing, in the denominator of the ratio, beds with the average daily census (ADC). Among the findings are: (1) Hospitals with small teaching programs would benefit from this switch more than hospitals with larger programs because of their generally lower occupancy rates, (2) The adjustment formula currently used for the capital prospective payment system (PPS) would alleviate this effect relative to the adjustment formula used for the operating PPS, (3) Although ADC appears to vary more on average, the weighted average rates of change in the resident-to-ADC ratios for a matched group of teaching hospitals are equal to the rates of change for the resident-to-bed ratios.</p><p>authors: N/A</p><p>issue_mesh: Bed Occupancy/economics/statistics &#x26; numerical data : Comparative Study : Education, Medical, Graduate/economics : Hospitals, Teaching/economics : Internship and Residency/statistics &#x26; numerical data : Medicare Part A/economics/statistics &#x26; numerical data : Prospective Payment System/economics : Rate Setting and Review/methods : Regression Analysis : Teaching/economics : United States</p><p>issue_number: 2</p><p>ntis_number: PB2001-105739</p><p>page_range: 59-68</p><p>primary_author: Phillips, Steven M</p><p>title: Measuring teaching intensity with the resident-to-average daily census ratio.</p><p>volume: 14</p><p>year_period: 1992 Winter</p>]]></description></item><item><title>Changes in Medicaid nursing home beds and residents.</title><pubDate>Mon, 04 Nov 2019 02:27:12 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191235</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191235</guid><description><![CDATA[<p>ntis_number: PB99-106460</p><p>page_range: 303-310</p><p>primary_author: Liu, Korbin</p><p>title: Changes in Medicaid nursing home beds and residents.</p><p>volume: Supp.</p><p>year_period: 1992 Supp.</p>]]></description></item><item><title>Simulating the fiscal and distributional impacts of Medicaid eligibility reforms.</title><pubDate>Mon, 04 Nov 2019 02:27:12 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191283</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191283</guid><description><![CDATA[<p>abstract: About 43 percent of nursing home costs are paid by Medicaid for the poor and for those who spend-down assets to qualify for Medicaid. We estimate the costs and distributional impacts of changes in the Medicaid asset test and the effect on the number of people spending down to Medicaid eligibility levels. Increasing asset thresholds from $2,00 to $12,000 would cost less than $4 billion, reduce spend-down rates, and increase the proportion of people eligible for Medicaid on admission to a nursing home. Even after such a change, about 80 percent of Medicaid benefits accrue to individuals with incomes less than $10,000.</p><p>authors: Kumar, Nanda; Wallack, Stanley S</p><p>issue_mesh: Aged : Computer Simulation : Costs and Cost Analysis/statistics &#x26; numerical data : Eligibility Determination/economics/legislation &#x26; jurisprudence : Financing, Personal/legislation &#x26; jurisprudence : Forecasting : Health Care Reform/economics : Human : Income : Medicaid/statistics &#x26; numerical data/utilization : Nursing Homes/economics : Support, Non-U.S. Gov't : United States</p><p>issue_number: 4</p><p>ntis_number: PB95-123485</p><p>page_range: 133-150</p><p>primary_author: Cohen, Marc A</p><p>title: Simulating the fiscal and distributional impacts of Medicaid eligibility reforms.</p><p>volume: 14</p><p>year_period: 1993 Summer</p>]]></description></item><item><title>A review of the first year of Medicare coverage of erythropoietin.</title><pubDate>Mon, 04 Nov 2019 02:27:12 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191313</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191313</guid><description><![CDATA[<p>abstract: Recombinant human erythropoietin (rHuEPO) is a new drug for treating anemia associated with end stage renal disease (ESRD). In a study of rHuEPO diffusion, costs, and effectiveness, we analyze ESRD program data and all claims submitted to Medicare for reimbursement of rHuEPO administered to ESRD dialysis patients. Access to rHuEPO was rapid and extensive during the first year of Medicare coverage. Dosing of rHuEPO and achieved hematocrit were lower than expected based on the results of clinical trials. rHuEPO cost Medicare $144 million in its first year. The analysis of insurance claims data allowed effective monitoring of access, costs, and effectiveness of this new biotechnology.</p><p>authors: Anderson, Gerald F; deLissovoy, Gregory; Eggers, Paul W; Greer, Joel W; Powe, Neil R; Watson, Alan J; Whelton, Paul K</p><p>issue_mesh: Blacks : Diffusion of Innovation : Drug Costs : Erythropoietin/economics/therapeutic use : Female : Health Services Accessibility/statistics &#x26; numerical data : Hemodialysis/economics/utilization : Human : Insurance, Pharmaceutical Services/statistics &#x26; numerical data/utilization : Kidney Failure, Chronic/drug therapy/economics : Male : Medicare/statistics &#x26; numerical data/utilization : Support, U.S. Gov't, Non-P.H.S. : Treatment Outcome : United States</p><p>issue_number: 3</p><p>ntis_number: PB95-123477</p><p>page_range: 83-102</p><p>primary_author: Griffiths, Robert I</p><p>title: A review of the first year of Medicare coverage of erythropoietin.</p><p>volume: 15</p><p>year_period: 1994 Spring</p>]]></description></item><item><title>Medicaid, welfare dependency, and work: is there a causal link?</title><pubDate>Mon, 04 Nov 2019 02:27:12 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191293</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191293</guid><description><![CDATA[<p>abstract: Medicaid exerts a strong "pull" on potential welfare recipients, increasing the probability that a number of single mothers will apply for and stay on welfare in order to be covered by Medicaid. However, the availability of private health insurance coverage exerts a strong positive influence on women's decisions to work and a strong negative effect on welfare participation rates. If private insurance coverage were as comprehensive as Medicaid and readily available at all jobs, its impact on promoting work would be substantially greater than is the impact of Medicaid in promoting the use of welfare.</p><p>authors: Wolfe, Barbara L</p><p>issue_mesh: Child : Choice Behavior : Data Collection : Dependency (Psychology) : Employment/economics/statistics &#x26; numerical data : Female : Human : Insurance, Health/statistics &#x26; numerical data : Medicaid/organization &#x26; administration/statistics &#x26; numerical data : Mothers/psychology : Poverty : Social Welfare/economics/psychology/statistics &#x26; numerical data : United States</p><p>issue_number: 1</p><p>ntis_number: PB95-123493</p><p>page_range: 123-133</p><p>primary_author: Moffitt, Robert</p><p>title: Medicaid, welfare dependency, and work: is there a causal link?</p><p>volume: 15</p><p>year_period: 1993 Fall</p>]]></description></item><item><title>Border crossing for physician services: implications for controlling expenditures.</title><pubDate>Mon, 04 Nov 2019 02:27:12 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191292</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191292</guid><description><![CDATA[<p>abstract: In this article, the authors explore geographic border crossing for the use of Medicare physician services. Using data from the 1988 Part B Medicare Annual Data (BMAD) file, they find that there is substantial geographic variation across both States and urban and rural areas in border crossing to seek services. As might be expected, there is more border crossing among smaller geographic areas than among States. Predominantly rural areas tend to be major importers of services, but urban areas, on average, export services. Border crossing tends to be greater for high-technology services such as advanced imaging, cardiovascular surgery, and oncology procedures. These results suggest that expenditure-control policies applying to States or metropolitan areas should incorporate adjusters for patients' current geographic patterns of care.</p><p>authors: Zuckerman, Stephen</p><p>issue_mesh: Catchment Area (Health)/economics/statistics &#x26; numerical data : Comparative Study : Data Collection : Geography : Health Expenditures/statistics &#x26; numerical data : Health Services Research : Health Services/statistics &#x26; numerical data/utilization : Medicare Assignment/statistics &#x26; numerical data : Medicare Part B/statistics &#x26; numerical data/utilization : Rural Population : Support, U.S. Gov't, Non-P.H.S. : Travel : United States : United States Health Care Financing Administration : Urban Population</p><p>issue_number: 1</p><p>ntis_number: PB95-123493</p><p>page_range: 101-122</p><p>primary_author: Holahan, John</p><p>title: Border crossing for physician services: implications for controlling expenditures.</p><p>volume: 15</p><p>year_period: 1993 Fall</p>]]></description></item><item><title>Skilled nursing facilities.</title><pubDate>Mon, 04 Nov 2019 02:27:12 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191225</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191225</guid><description><![CDATA[<p>ntis_number: PB99-106460</p><p>page_range: 97-123</p><p>primary_author: Helbing, Charles</p><p>title: Skilled nursing facilities.</p><p>volume: Supp.</p><p>year_period: 1992 Supp.</p>]]></description></item><item><title>Use of outpatient drugs as death approaches.</title><pubDate>Mon, 04 Nov 2019 02:27:12 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191312</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191312</guid><description><![CDATA[<p>abstract: This article explores changes in outpatient prescription drug use up to 72 months prior to death and relates the findings to trends in Medicare-covered services during the same life stage. The study sample comprises 5,261 decedents who, prior to their deaths, had enrolled in the Pennsylvania Pharmaceutical Assistance Contract for the Elderly (PACE) program. Descriptive time-series show steady increases in both outpatient drug use and physician contacts in the final 36 months of life. However, multivariate analysis shows that impending death is associated with significant reductions in the probability of using outpatient drugs. Only in the final 12 months of life is this effect offset by rising numbers of drug claims by prescription users.</p><p>authors: Coulson, N Edward</p><p>issue_mesh: Aged : Ambulatory Care/economics : Data Collection : Drug Utilization/statistics &#x26; numerical data : Health Services Research/methods : Human : Insurance, Pharmaceutical Services/statistics &#x26; numerical data/utilization : Medicare/statistics &#x26; numerical data/utilization : Outpatients/statistics &#x26; numerical data : Pennsylvania : Prescriptions, Drug/economics : Support, U.S. Gov't, Non-P.H.S. : Terminal Care/economics/utilization : Time Factors : United States</p><p>issue_number: 3</p><p>ntis_number: PB95-123477</p><p>page_range: 63-82</p><p>primary_author: Stuart, Bruce</p><p>title: Use of outpatient drugs as death approaches.</p><p>volume: 15</p><p>year_period: 1994 Spring</p>]]></description></item><item><title>A clinically based service limitation option for alternative model rural hospitals.</title><pubDate>Mon, 04 Nov 2019 02:27:12 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191302</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191302</guid><description><![CDATA[<p>abstract: Alternative model rural hospitals are designed to address problems faced by small, isolated rural hospitals. Typically, hospital regulations are reduced in exchange for a limit on the services that alternative models may offer. The most common service limitation is a limit on length of stay (LOS), a method with little empirical or conceptual support. The purpose of this article is to present a clinically based service limitation for alternative model rural hospitals, such as the rural primary care hospital. The proposal is based on an analysis of Medicare discharges from rural hospitals most likely to convert and the judgments of a technical advisory panel of rural clinicians.</p><p>authors: Chen, Mei M; Christianson, Jon B; Sales, Anne; Wellever, Anthony L</p><p>issue_mesh: Aged : Data Collection : Diagnosis-Related Groups/legislation &#x26; jurisprudence/statistics &#x26; numerical data : Health Services Research : Hospital Planning/legislation &#x26; jurisprudence : Hospitals, Rural/economics/legislation &#x26; jurisprudence/utilization : Human : Length of Stay/economics/legislation &#x26; jurisprudence : Medicare Part A/legislation &#x26; jurisprudence : Models, Organizational : Patient Transfer/statistics &#x26; numerical data : Professional Review Organizations : Support, U.S. Gov't, Non-P.H.S. : United States : Utilization Review</p><p>issue_number: 2</p><p>ntis_number: PB95-123469</p><p>page_range: 103-119</p><p>primary_author: Moscovice, Ira S</p><p>title: A clinically based service limitation option for alternative model rural hospitals.</p><p>volume: 15</p><p>year_period: 1993 Winter</p>]]></description></item><item><title>The impact of Medicaid adoption of the Medicare fee schedule.</title><pubDate>Mon, 04 Nov 2019 02:27:12 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191263</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191263</guid><description><![CDATA[<p>abstract: In this article, the authors simulate the effects on Federal and State Medicaid expenditures of increasing Medicaid fees to Medicare fee schedule (MFS) levels. Strict adoption of the MFS by the States would increase total Medicaid spending by approximately 4 percent, $2.5 to $2.9 billion. Because Medicaid fees vary across States, so does the impact of adopting the MFS. Medicaid spending would increase significantly in some wealthy States with large Medicaid populations and in a few small, relatively poor States. Some States currently pay more than the MFS for obstetrical services. If these fees continued at higher levels for obstetrical care, total Medicaid spending would increase by $3.5 to $4.0 billion.</p><p>authors: Gates, Michael; Tsoflias, Lynn; Wade, Martcia</p><p>issue_mesh: Fee Schedules : Adult : Behavior : Child : Fees, Medical/statistics &#x26; numerical data : Health Expenditures/trends : Human : Insurance, Physician Services/economics : Linear Models : Medicaid/economics/utilization : Medicare Part B/economics : Models, Statistical : State Health Plans/economics : Support, U.S. Gov't, Non-P.H.S. : United States</p><p>issue_number: 3</p><p>ntis_number: PB95-111274</p><p>page_range: 11-24</p><p>primary_author: Holahan, John</p><p>title: The impact of Medicaid adoption of the Medicare fee schedule.</p><p>volume: 14</p><p>year_period: 1993 Spring</p>]]></description></item><item><title>Recent trends in Medicaid expenditures.</title><pubDate>Mon, 04 Nov 2019 02:27:12 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191233</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191233</guid><description><![CDATA[<p>ntis_number: PB99-106460</p><p>page_range: 271-283</p><p>primary_author: Buck, Jeffrey A</p><p>title: Recent trends in Medicaid expenditures.</p><p>volume: Supp.</p><p>year_period: 1992 Supp.</p>]]></description></item><item><title>Price controls: on the one hand ... and on the other.</title><pubDate>Mon, 04 Nov 2019 02:27:12 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191262</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191262</guid><description><![CDATA[<p>abstract: Controlling health care costs requires that limits be placed either on prices, quantities of services, or both. Prices are measurable and more easily controlled than is quantity and, consequently, health care cost containment has frequently focused on mechanisms for controlling prices. Regulatory approaches, however, may create market distortions and change access patterns. An alternative approach to controlling prices is to restructure the market for health services to encourage greater price competition among providers. Because this type of health reform has not previously been attempted, there is much more uncertainty about the outcome of market-oriented approaches than for direct regulatory control over prices.</p><p>authors: N/A</p><p>issue_mesh: National Health Insurance, United States : Budgets/legislation &#x26; jurisprudence : Cost Control/legislation &#x26; jurisprudence : Economic Competition/economics : Government Agencies : Health Care Reform/economics : Health Expenditures/legislation &#x26; jurisprudence : Medicare/economics/organization &#x26; administration : Program Evaluation : Rate Setting and Review/legislation &#x26; jurisprudence : United States</p><p>issue_number: 3</p><p>ntis_number: PB95-111274</p><p>page_range: 5-10</p><p>primary_author: Langwell, Kathryn M</p><p>title: Price controls: on the one hand ... and on the other.</p><p>volume: 14</p><p>year_period: 1993 Spring</p>]]></description></item><item><title>Medicare enrollment.</title><pubDate>Mon, 04 Nov 2019 02:27:12 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191222</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191222</guid><description><![CDATA[<p>ntis_number: PB99-106460</p><p>page_range: 13-22</p><p>primary_author: Petrie, John T</p><p>title: Medicare enrollment.</p><p>volume: Supp.</p><p>year_period: 1992 Supp.</p>]]></description></item><item><title>Price indexes for pharmaceuticals used by the elderly.</title><pubDate>Mon, 04 Nov 2019 02:27:12 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191242</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191242</guid><description><![CDATA[<p>abstract: The analysis presented in this report was undertaken to identify those drug entities that account for a significant proportion of the retail expenditures for prescription drugs used by the elderly. Commercial data bases were used to develop fixed weight Laspeyres price indexes based specifically on drugs used in the elderly population. The indexes provide the capability to analyze price trends for drug groupings that are not possible with the producer price index (PPI) or the Consumer Price Index (CPI). From 1981 through 1988, the average annual rate of increase in manufacturers' prices was 9.1 percent, and retail prices increased at an average annual rate of 6.6 percent. The indexes represent potentially powerful tools in analyzing drug price trends, an important component of drug program expenditure forecasting and management.</p><p>authors: Schondelmeyer, Stephen</p><p>issue_mesh: Aged : Data Collection : Databases, Factual : Drug Industry/economics : Drug Utilization/economics/statistics &#x26; numerical data : Health Expenditures/statistics &#x26; numerical data/trends : Human : Prescription Fees/statistics &#x26; numerical data/trends : Prescriptions, Drug/economics/statistics &#x26; numerical data : United States</p><p>issue_number: 1</p><p>ntis_number: PB95-123279</p><p>page_range: 91-105</p><p>primary_author: Thomas 3d, Joseph</p><p>title: Price indexes for pharmaceuticals used by the elderly.</p><p>volume: 14</p><p>year_period: 1992 Fall</p>]]></description></item><item><title>Health care indicators</title><pubDate>Mon, 04 Nov 2019 02:27:11 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191345</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191345</guid><description><![CDATA[<p>abstract: This regular feature of the journal includes a discussion of each of the following four topics: community hospital statistics; employment, hours, and earnings in the private health sector; health care prices; and national economic indicators. These statistics are valuable in their own right for understanding the relationship between the health care sector and the overall economy. In addition, they allow us to anticipate the direction and magnitude of health care cost changes prior to the availability of more comprehensive data.</p><p>authors: Maple, Brenda T; Sensenig, Arthur L</p><p>issue_mesh: Data Collection : Employment/statistics &#x26; numerical data/trends : Health Care Sector/statistics &#x26; numerical data : Health Expenditures/statistics &#x26; numerical data/trends : Health Personnel/economics : Hospitals, Community/statistics &#x26; numerical data/trends : Length of Stay/statistics &#x26; numerical data/trends : Salaries and Fringe Benefits/statistics &#x26; numerical data/trends : United States : United States Health Care Financing Administration</p><p>issue_number: 1</p><p>ntis_number: PB2001-105546</p><p>page_range: 295-301</p><p>primary_author: Donham, Carolyn S</p><p>title: Health care indicators</p><p>volume: 16</p><p>year_period: 1994 Fall</p>]]></description></item><item><title>Refinement of the Medicare diagnosis-related groups to incorporate a measure of severity.</title><pubDate>Mon, 04 Nov 2019 02:27:11 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191348</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191348</guid><description><![CDATA[<p>abstract: This article presents a system under consideration by the Health Care Financing Administration (HCFA) for incorporating a measure of severity of illness into the Medicare diagnosis-related groups (DRGs). DRG assignment is one of the main factors in determining the payment made for hospital inpatient services furnished to Medicare beneficiaries. Specifically, the formula used to calculate payment for a single Medicare hospital inpatient case takes an average payment rate for a typical case and multiplies it by the relative weight of the DRG to which it is assigned. Thus, it is easy to see that the DRG relative weights have a large impact on the payment a hospital receives. In this article, we describe the Medicare DRG prospective payment system (PPS), evaluate the various classification elements available for assessing severity of illness, describe the analyses used in formulating this proposal, and present the proposed DRG severity system.</p><p>authors: Burley, Dana; Honemann, Dorothy; Navarro, Maria</p><p>issue_mesh: Severity of Illness Index : Comorbidity : Diagnosis-Related Groups/classification/economics : Evaluation Studies : Medical Records/classification : Medicare/economics : United States : United States Health Care Financing Administration</p><p>issue_number: 2</p><p>ntis_number: PB99-106486</p><p>page_range: 45-64</p><p>primary_author: Edwards, Nancy</p><p>title: Refinement of the Medicare diagnosis-related groups to incorporate a measure of severity.</p><p>volume: 16</p><p>year_period: 1994 Winter</p>]]></description></item><item><title>Trends in length of stay for Medicare patients: 1979-87.</title><pubDate>Mon, 04 Nov 2019 02:27:11 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191303</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191303</guid><description><![CDATA[<p>abstract: Hospital length of stay (LOS) declined steadily during the 1970s, then rapidly during the early years of the Medicare prospective payment system (PPS). In this article, the authors examine trends in hospital LOS for Medicare patients from 1979 through 1987 for all cases combined, for medical and surgical cases separately, and for different geographic regions. The increase in LOS for surgical cases from 1985 through 1987 represented two offsetting trends. Continuing declines in LOS for most procedures were offset by an increased shift toward complex, long LOS procedures.</p><p>authors: Witsberger, Christina J</p><p>issue_mesh: Aged : Data Collection : Diagnosis-Related Groups/statistics &#x26; numerical data : Geography : Health Services Research : Hospitals/utilization : Human : Length of Stay/statistics &#x26; numerical data/trends : Medicare Part A/statistics &#x26; numerical data/utilization : Prospective Payment System/statistics &#x26; numerical data : Support, U.S. Gov't, Non-P.H.S. : Surgical Procedures, Operative/economics/utilization : United States</p><p>issue_number: 2</p><p>ntis_number: PB95-123469</p><p>page_range: 121-135</p><p>primary_author: Kominski, Gerald F</p><p>title: Trends in length of stay for Medicare patients: 1979-87.</p><p>volume: 15</p><p>year_period: 1993 Winter</p>]]></description></item><item><title>Measuring and assuring the quality of home health care.</title><pubDate>Mon, 04 Nov 2019 02:27:11 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191336</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191336</guid><description><![CDATA[<p>abstract: The growth in home health care in the United States since 1970, and the exponential increase in the provision of Medicare-covered home health services over the past 5 years, underscores the critical need to assess the effectiveness of home health care in our society. This article presents conceptual and applied topics and approaches involved in assessing effectiveness through measuring the outcomes of home health care. Definitions are provided for a number of terms that relate to quality of care, outcome measures, risk adjustment, and quality assurance (QA) in home health care. The goal is to provide an overview of a potential systemwide approach to outcome-based QA that has its basis in a partnership between the home health industry and payers or regulators.</p><p>authors: Arnold, Angela G; Crisler, Kathryn S; Hittle, David F; Kramer, Andrew M; Powell, Martha C; Schlenker, Robert E</p><p>issue_mesh: Data Collection : Evaluation Studies : Health Services Research : Health Status : Home Care Services/statistics &#x26; numerical data/standards : Human : Medicare/statistics &#x26; numerical data/standards : Models, Theoretical : Outcome Assessment (Health Care)/organization &#x26; administration/statistics &#x26; numerical data : Program Development : Quality Assurance, Health Care/organization &#x26; administration/statistics &#x26; numerical data : Quality of Life : Research Design : Risk Assessment : Support, Non-U.S. Gov't : Support, U.S. Gov't, Non-P.H.S. : United States</p><p>issue_number: 1</p><p>ntis_number: PB2001-105546</p><p>page_range: 35-67</p><p>primary_author: Shaughnessy, Peter W</p><p>title: Measuring and assuring the quality of home health care.</p><p>volume: 16</p><p>year_period: 1994 Fall</p>]]></description></item><item><title>Health care indicators</title><pubDate>Mon, 04 Nov 2019 02:27:11 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191295</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191295</guid><description><![CDATA[<p>abstract: On August 10, 1993, the President signed into law the Omnibus Budget Reconciliation Act (OBRA) of 1993 (Public Law 103-66). Following are summaries of the Medicare, Medicaid, and other relevant provisions.</p><p>authors: Letsch, Suzanne W; Maple, Brenda T</p><p>issue_mesh: Budgets/legislation &#x26; jurisprudence : Deductibles and Coinsurance/legislation &#x26; jurisprudence : Economics, Hospital/legislation &#x26; jurisprudence : Education, Medical, Graduate/economics : Health Maintenance Organizations/economics/legislation &#x26; jurisprudence : Insurance, Health, Reimbursement/legislation &#x26; jurisprudence : Medicaid/legislation &#x26; jurisprudence : Medicare Part A/legislation &#x26; jurisprudence : Medicare Part B/legislation &#x26; jurisprudence : Medicare/legislation &#x26; jurisprudence : United States</p><p>issue_number: 1</p><p>ntis_number: PB95-123493</p><p>page_range: 147-176</p><p>primary_author: Donham, Carolyn S</p><p>title: Health care indicators</p><p>volume: 15</p><p>year_period: 1993 Fall</p>]]></description></item><item><title>National health expenditures, 1993.</title><pubDate>Mon, 04 Nov 2019 02:27:11 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191344</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191344</guid><description><![CDATA[<p>abstract: This article presents data on health care spending for the United States, covering expenditures for various types of medical services and products and their sources of funding from 1960 to 1993. Although these statistics show a slowing in the growth of health care expenditures over the past few years, spending continues to increase faster than the overall economy. The share of the Nation's health care bill funded by the Federal Government through the Medicaid and Medicare programs steadily increased from 1991 to 1993. This significant change in the share of health expenditures funded by the public sector has caused Federal health expenditures as a share of all Federal spending to increase dramatically.</p><p>authors: Cowan, Cathy A; Donham, Carolyn S; Lazenby, Helen C; McDonnell, Patricia A; Sensenig, Arthur L; Sivarajan, Lekha; Stewart, Madie W; Stiller, Jean M; Won, Darleen K</p><p>issue_mesh: Comparative Study : Cost Allocation/statistics &#x26; numerical data : Data Collection : Health Expenditures/classification/statistics &#x26; numerical data/trends : Health Services/classification/economics : Medicaid/statistics &#x26; numerical data/trends : Medicare/statistics &#x26; numerical data/trends : Public Sector : United States</p><p>issue_number: 1</p><p>ntis_number: PB2001-105546</p><p>page_range: 247-294</p><p>primary_author: Levit, Katharine R</p><p>title: National health expenditures, 1993.</p><p>volume: 16</p><p>year_period: 1994 Fall</p>]]></description></item><item><title>Recent innovations in home health care policy research</title><pubDate>Mon, 04 Nov 2019 02:27:11 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191333</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191333</guid><description><![CDATA[<p>authors: N/A</p><p>issue_mesh: Health Care Reform : Health Services Research : Home Care Services/economics/organization &#x26; administration : Insurance Benefits : Medicare/organization &#x26; administration/utilization : Organizational Innovation : Organizational Policy : Policy Making : United States : United States Health Care Financing Administration</p><p>issue_number: 1</p><p>ntis_number: PB2001-105546</p><p>page_range: 1-6</p><p>primary_author: Clauser, Steven B</p><p>title: Recent innovations in home health care policy research</p><p>volume: 16</p><p>year_period: 1994 Fall</p>]]></description></item><item><title>RUG-II (Resource Utilization Group, Version II) impacts on long-term care facilities in New York.</title><pubDate>Mon, 04 Nov 2019 02:27:11 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191350</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191350</guid><description><![CDATA[<p>abstract: This article observes changes during the first 5 years of Resource Utilization Group, Version II (RUG-II) system utilization by the New York State Department of Health (NYDOH) for Medicaid program reimbursement. Findings include a dramatic increase in the number of residents scoring in the highest intensity resident-care categories, a substantial increase in staffing and expenditures for rehabilitation therapies, and a possible negative impact on the financial performance of New York long-term care (LTC) facilities. RUG-II appears to have been successful in improving access to nursing homes for individuals with heavy-care needs and in encouraging the appropriate utilization of institutionalized skilled nursing care.</p><p>authors: Knickman, James R; Ward, David</p><p>issue_mesh: Cost Allocation : Diagnosis-Related Groups/classification/economics : Financial Management/trends : Health Services Research : Long-Term Care/classification/economics : Medicaid/statistics &#x26; numerical data/trends : New York : Nursing Homes/economics/statistics &#x26; numerical data/utilization : Personnel Staffing and Scheduling/trends : Rehabilitation/classification/economics : Reimbursement Mechanisms/trends : State Health Plans/economics/statistics &#x26; numerical data/trends : Support, Non-U.S. Gov't : United States</p><p>issue_number: 2</p><p>ntis_number: PB99-106486</p><p>page_range: 85-99</p><p>primary_author: Schultz, Barry M</p><p>title: RUG-II (Resource Utilization Group, Version II) impacts on long-term care facilities in New York.</p><p>volume: 16</p><p>year_period: 1994 Winter</p>]]></description></item><item><title>Post-hospital home health care for Medicare patients.</title><pubDate>Mon, 04 Nov 2019 02:27:11 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191340</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191340</guid><description><![CDATA[<p>abstract: Medicare patients in five diagnosis-related groups (DRGs) associated with heavy use of post-hospital care discharged from 52 hospitals in 3 cities were followed up at 6 weeks, 6 months, and 1 year to determine the factors associated with their being discharged home with or without home health care and the correlates of improvement in their functional status. Models correctly predicted those discharged home from those going to institutions in a range from 54 to 82 percent of cases. The amount of the variance in the change in function for those who went home (with or without home health care) explained by the models tested ranged from 19 percent to 73 percent. Total Medicare costs for the patients who went home were considerably less in the year subsequent to the hospitalization compared with those discharged to institutional care.</p><p>authors: Blewett, Lynn A; Burns, Risa; Chen, Qing; Finch, Michael; Moskowitz, Mark A</p><p>issue_mesh: Activities of Daily Living : Aftercare/economics/statistics &#x26; numerical data/utilization : Aged : Data Collection : Diagnosis-Related Groups : Female : Health Expenditures : Health Services Research : Home Care Services/economics/statistics &#x26; numerical data/utilization : Human : Least-Squares Analysis : Logistic Models : Longitudinal Studies : Male : Medicare/statistics &#x26; numerical data/utilization : Minnesota : Odds Ratio : Outcome Assessment (Health Care)/statistics &#x26; numerical data : Pennsylvania : Support, U.S. Gov't, Non-P.H.S. : Texas : United States</p><p>issue_number: 1</p><p>ntis_number: PB2001-105546</p><p>page_range: 131-153</p><p>primary_author: Kane, Robert L</p><p>title: Post-hospital home health care for Medicare patients.</p><p>volume: 16</p><p>year_period: 1994 Fall</p>]]></description></item><item><title>Differences by race in the rates of procedures performed in hospitals for Medicare beneficiaries.</title><pubDate>Mon, 04 Nov 2019 02:27:11 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191325</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191325</guid><description><![CDATA[<p>abstract: This study analyzes administrative data from the Medicare program to compare differences by race in the use of 17 major procedures performed in the hospital. In both 1986 and 1992, black beneficiaries were less likely than white beneficiaries to have received these procedures while hospitalized. The largest differences were seen for "referral-sensitive surgeries" such as percutaneous transluminal coronary angioplasty, coronary artery bypass graft surgery, total knee replacement, and total hip replacement. These differences by race suggest that there are barriers to these services. In contrast, black beneficiaries were found to have substantially higher rates than white beneficiaries in the use of four procedures performed in the hospital: amputation of part of the lower limb, surgical debridement, arteriovenostomy, and bilateral orchiectomy. The types of procedures for which black beneficiaries have higher rates raise questions about whether there is a need for more comprehensive and continuous ambulatory care for the underlying health conditions associated with these procedures.</p><p>authors: Gornick, Marian</p><p>issue_mesh: Aged : Blacks/statistics &#x26; numerical data : Comparative Study : Data Collection : Health Services Accessibility : Health Services Research : Hospitalization/statistics &#x26; numerical data : Human : Medicare/utilization : Odds Ratio : Referral and Consultation : Surgical Procedures, Operative/statistics &#x26; numerical data/trends/utilization : United States : Utilization Review : Whites/statistics &#x26; numerical data</p><p>issue_number: 4</p><p>ntis_number: PB99-106437</p><p>page_range: 77-90</p><p>primary_author: McBean, A Marshall</p><p>title: Differences by race in the rates of procedures performed in hospitals for Medicare beneficiaries.</p><p>volume: 15</p><p>year_period: 1994 Summer</p>]]></description></item><item><title>Political perspectives on uncertified home care agencies.</title><pubDate>Mon, 04 Nov 2019 02:27:11 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191343</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191343</guid><description><![CDATA[<p>abstract: This article examines the political agendas of public sector and organized private sector interests concerned with policies affecting uncertified home care agencies in three metropolitan areas. Using a telephone survey, the study found substantial differences across these groups in both the frequency with which they work on given issues and in some key attitudes. Overall, respondents were most likely to work on policies related to home care quality, and had particularly diverse--and at times conflicting--concerns in this area. Policymakers need to actively solicit the diverse attitudes of key interest groups towards controversial issues in order to understand less dominant perspectives, keep in mind the interconnection of policy issues, and arrive at politically viable solutions to home care policy problems.</p><p>authors: Estes, Carroll L; Harrington, Charlene</p><p>issue_mesh: Organizational Policy : Politics : Certification/legislation &#x26; jurisprudence : Health Services Research : Home Care Agencies/legislation &#x26; jurisprudence/statistics &#x26; numerical data/standards : Interviews : Philadelphia : Private Sector/statistics &#x26; numerical data : Public Sector/statistics &#x26; numerical data : Quality of Health Care : San Francisco : Support, U.S. Gov't, P.H.S. : Texas</p><p>issue_number: 1</p><p>ntis_number: PB2001-105546</p><p>page_range: 223-245</p><p>primary_author: Silberberg, Mina</p><p>title: Political perspectives on uncertified home care agencies.</p><p>volume: 16</p><p>year_period: 1994 Fall</p>]]></description></item><item><title>Diffusion of Medicare's RBRVS and related physician payment policies.</title><pubDate>Mon, 04 Nov 2019 02:27:11 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191353</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191353</guid><description><![CDATA[<p>abstract: In 1992, Medicare reformed its physician payment method by implementing the Medicare fee schedule (MFS), of which the resource-based relative value scale (RBRVS) is a major component. Using a recent survey and case studies, we examine the diffusion of Medicare's RBRVS to non-Medicare payers and how those payers use and perceive the RBRVS and MFS policies. We find that approximately one-third of payers that participated in the survey have adopted RBRVS-based payment systems in varying degrees while another 40 percent were seriously considering its adoption. Prospects for expanded use of Medicare's RBRVS appear favorable.</p><p>authors: Burge, Russel T</p><p>issue_mesh: Diffusion of Innovation : Fee Schedules : Relative Value Scales : Cost-Benefit Analysis : Health Services Research : Insurance, Physician Services/statistics &#x26; numerical data/trends : Medicare Part B/organization &#x26; administration : Questionnaires : Reimbursement Mechanisms/trends : Support, U.S. Gov't, Non-P.H.S. : United States</p><p>issue_number: 2</p><p>ntis_number: PB99-106486</p><p>page_range: 159-173</p><p>primary_author: McCormack, Lauren A</p><p>title: Diffusion of Medicare's RBRVS and related physician payment policies.</p><p>volume: 16</p><p>year_period: 1994 Winter</p>]]></description></item><item><title>Home health care outcomes under capitated and fee-for-service payment.</title><pubDate>Mon, 04 Nov 2019 02:27:11 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191342</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191342</guid><description><![CDATA[<p>abstract: In this article, case-mix-adjusted outcomes of home health care are found to be superior for Medicare fee-for-service (FFS) patients relative to Medicare health maintenance organization (HMO) patients. The superior outcomes for FFS patients were accompanied by higher utilization and cost of home health services, suggesting a volume-outcome (or dose-response) relationship that was further substantiated by within-HMO and within-FFS analyses. The findings suggest that greater attention should be paid to both outcome-based quality assurance and managed care practices that may be overly restrictive in terms of the use of home health services.</p><p>authors: Hittle, David F; Schlenker, Robert E</p><p>issue_mesh: Capitation Fee : Comparative Study : Data Collection : Diagnosis-Related Groups : Fee-for-Service Plans/standards : Health Maintenance Organizations/standards : Home Care Services/economics/statistics &#x26; numerical data/standards : Medicare/statistics &#x26; numerical data : Outcome Assessment (Health Care)/statistics &#x26; numerical data : Quality of Health Care/economics : Support, U.S. Gov't, Non-P.H.S. : United States</p><p>issue_number: 1</p><p>ntis_number: PB2001-105546</p><p>page_range: 187-222</p><p>primary_author: Shaughnessy, Peter W</p><p>title: Home health care outcomes under capitated and fee-for-service payment.</p><p>volume: 16</p><p>year_period: 1994 Fall</p>]]></description></item><item><title>Medicaid policies for AIDS-related hospital care.</title><pubDate>Mon, 04 Nov 2019 02:27:11 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191322</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191322</guid><description><![CDATA[<p>abstract: With hospital services comprising an important part of care related to acquired immunodeficiency syndrome (AIDS), and all Medicaid programs becoming major payers of these services, Medicaid policies affect the care that Medicaid recipients with AIDS receive. Many States pay hospitals on the basis of prospective payments that do not vary with patient diagnosis. In contrast, Medicaid programs using diagnosis-related group (DRG) payment methods adjust payments to reflect the greater cost of AIDS care. At least 12 Medicaid programs limited the number of paid inpatient hospital days during 1992; Medicaid recipients with AIDS could easily exceed such limits.</p><p>authors: Kircher, Fred G</p><p>issue_mesh: Acquired Immunodeficiency Syndrome/economics : Diagnosis-Related Groups/economics : Health Services Research : Hospital Costs : Hospitalization/economics/statistics &#x26; numerical data : Human : Length of Stay : Medicaid/organization &#x26; administration/statistics &#x26; numerical data : Questionnaire : Reimbursement Mechanisms/economics : State Health Plans : Support, U.S. Gov't, P.H.S. : United States</p><p>issue_number: 4</p><p>ntis_number: PB99-106437</p><p>page_range: 33-41</p><p>primary_author: Buchanan, Robert J</p><p>title: Medicaid policies for AIDS-related hospital care.</p><p>volume: 15</p><p>year_period: 1994 Summer</p>]]></description></item><item><title>Do preset per visit payment rates affect home health agency behavior?</title><pubDate>Mon, 04 Nov 2019 02:27:11 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191338</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191338</guid><description><![CDATA[<p>abstract: This article reports on preliminary impacts during the first year of a demonstration in which home health agencies (HHAs) were paid a prospectively set rate for each Medicare home health visit rendered, rather than being reimbursed for costs. Forty-seven agencies in five States participated. The evaluation compared the experiences of randomly assigned treatment agencies and their patients with those of control agencies and their patients and found no compelling evidence of any demonstration impact on agency cost per visit, the volume of home health services, agency revenue and profit, patient selection and retention, quality of care, or use and cost of Medicare services.</p><p>authors: Bishop, Christine E; Brown, Randall S; Klein, Amy C; Ritter, Grant A; Schore, Jennifer L; Skwara, Kathleen C; Thornton, Craig V</p><p>issue_mesh: Costs and Cost Analysis : Data Collection : Evaluation Studies : Health Services Research : Home Care Agencies/economics/statistics &#x26; numerical data/utilization : Medicare/economics/statistics &#x26; numerical data : Prospective Payment System/trends : Rate Setting and Review/methods : Regression Analysis : Reimbursement, Incentive/statistics &#x26; numerical data : Reproducibility of Results : Support, U.S. Gov't, Non-P.H.S. : United States</p><p>issue_number: 1</p><p>ntis_number: PB2001-105546</p><p>page_range: 91-107</p><p>primary_author: Phillips, Barbara R</p><p>title: Do preset per visit payment rates affect home health agency behavior?</p><p>volume: 16</p><p>year_period: 1994 Fall</p>]]></description></item><item><title>Use of diagnosis-related groups by non-Medicare payers.</title><pubDate>Mon, 04 Nov 2019 02:27:11 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191352</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191352</guid><description><![CDATA[<p>abstract: Medicare's prospective payment system (PPS) for hospital cases is based on diagnosis-related groups (DRGs). A wide variety of other third-party payers for hospital care have adapted elements of this system for their own use. The extent of DRG use varies considerably both by type of payer and by geographical area. Users include: 21 State Medicaid programs, 3 workers' compensation systems, the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS), more than one-half of the Blue Cross and Blue Shield Association (BCBSA) member plans, several self-insured employers, and a few employer coalitions. We describe how each of these payers use DRGs. No single approach is dominant. Some payers negotiate specific prices for so many combinations of DRG and hospital that the paradigm that payment equals rate times weight does not apply. What has emerged appears to be a very flexible payment system in which the only constant is the use of DRGs as a measure of output.</p><p>authors: Jacobson, Peter D; Kominski, Gerald F; Perry, Mark J</p><p>issue_mesh: Data Collection : Diagnosis-Related Groups/economics/statistics &#x26; numerical data/utilization : Health Benefit Plans, Employee : Health Services Research : Insurance Carriers/trends : Insurance, Hospitalization/standards/trends : Managed Care Programs : Medicaid : Models, Organizational : Prospective Payment System/statistics &#x26; numerical data/utilization : Rate Setting and Review/methods : Support, U.S. Gov't, Non-P.H.S. : United States : Workers' Compensation</p><p>issue_number: 2</p><p>ntis_number: PB99-106486</p><p>page_range: 127-158</p><p>primary_author: Carter, Grace M</p><p>title: Use of diagnosis-related groups by non-Medicare payers.</p><p>volume: 16</p><p>year_period: 1994 Winter</p>]]></description></item><item><title>Medicare inpatient physician charges: an econometric analysis.</title><pubDate>Mon, 04 Nov 2019 02:27:11 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191305</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191305</guid><description><![CDATA[<p>abstract: To control Medicare physician payments, Congress in 1989 established volume performance standards (VPS) that tie future physician fee increases to the growth in expenditures per beneficiary. The VPS risk pool is nationwide, and many observers believe it is too large to affect behavior. VPS could be modified by defining a separate risk pool for inpatient physician services and placing each hospital medical staff at risk for those services. Using a national random sample of 500,000 Medicare admissions, we explore the determinants of medical staff charges and comment on the policy implications. Multivariate analysis shows that charges increase with case mix and bed size but, surprisingly, decrease with the level of teaching activity. The teaching result is explained by the substitution of residents for physicians in these hospitals.</p><p>authors: Welch, W Pete</p><p>issue_mesh: Relative Value Scales : Analysis of Variance : Diagnosis-Related Groups/economics : Education, Medical, Graduate/economics : Fee Schedules/legislation &#x26; jurisprudence/statistics &#x26; numerical data : Health Services Research : Hospital Bed Capacity/statistics &#x26; numerical data : Hospitals, Teaching/economics : Medical Staff, Hospital/economics : Medicare Part B/economics/statistics &#x26; numerical data : Models, Econometric : Multivariate Analysis : Reimbursement Mechanisms/economics : Support, U.S. Gov't, Non-P.H.S. : United States</p><p>issue_number: 2</p><p>ntis_number: PB95-123469</p><p>page_range: 155-171</p><p>primary_author: Miller, Mark E</p><p>title: Medicare inpatient physician charges: an econometric analysis.</p><p>volume: 15</p><p>year_period: 1993 Winter</p>]]></description></item><item><title>Effects of selected cost-containment efforts: 1971-1993.</title><pubDate>Mon, 04 Nov 2019 02:27:11 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191272</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191272</guid><description><![CDATA[<p>authors: Chu, Karyen; Felt, Suzanne; Harrington, Mary; Lake, Timothy</p><p>issue_mesh: Comparative Study : Cost Control/history/legislation &#x26; jurisprudence : Health Expenditures/legislation &#x26; jurisprudence/trends : Health Services Accessibility/trends : History of Medicine, 20th Cent. : Hospital Costs/legislation &#x26; jurisprudence/trends : Inflation, Economic/legislation &#x26; jurisprudence : Medicare Part A/legislation &#x26; jurisprudence : Medicare Part B/legislation &#x26; jurisprudence : Prospective Payment System/legislation &#x26; jurisprudence : Quality of Health Care/trends : Relative Value Scales : State Health Plans/legislation &#x26; jurisprudence : Support, U.S. Gov't, P.H.S. : United States</p><p>issue_number: 3</p><p>ntis_number: PB95-111274</p><p>page_range: 183-225</p><p>primary_author: Gold, Marsha</p><p>title: Effects of selected cost-containment efforts: 1971-1993.</p><p>volume: 14</p><p>year_period: 1993 Spring</p>]]></description></item><item><title>Utilization effects of prescription drug benefits in an aging population.</title><pubDate>Mon, 04 Nov 2019 02:27:11 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191315</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191315</guid><description><![CDATA[<p>abstract: In this article, the effects of prescription drug coverage on use are analyzed for beneficiaries of a large retiree health benefit fund in a quasi-experiment comparing new and established enrollees. Newer enrollees show an 18-percentage point greater increase in prescription drug expenditures per capita than established enrollees during the 3-year period following enrollment. This differential is interpreted as the insurance effect of prescription coverage. The impact was greater among high-cost drugs than among low-cost drugs, and also greater among low users of prescription drugs than among high users. No clear patterns were discerned across therapeutic categories.</p><p>authors: Baines, Arthur P; Richards, David</p><p>issue_mesh: Aged : Cost Sharing : Drug Costs/statistics &#x26; numerical data : Drug Utilization/economics/statistics &#x26; numerical data : Health Benefit Plans, Employee/utilization : Health Services Research/methods : Human : Insurance, Pharmaceutical Services/utilization : Labor Unions : Retirement/economics</p><p>issue_number: 3</p><p>ntis_number: PB95-123477</p><p>page_range: 113-126</p><p>primary_author: Gianfrancesco, Frank D</p><p>title: Utilization effects of prescription drug benefits in an aging population.</p><p>volume: 15</p><p>year_period: 1994 Spring</p>]]></description></item><item><title>Global budgeting in the OECD countries.</title><pubDate>Mon, 04 Nov 2019 02:27:10 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191266</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191266</guid><description><![CDATA[<p>abstract: Many of the Organization for Economic Cooperation and Development countries use global budgeting to control all or certain portions of their health care expenditures. Although the use of global budgets as a cost-containment tool has not been implemented in the United States in any comprehensive way, recent health care reform initiatives have increased the need for research into such tools. In general, the structure, process, and effectiveness of global budgets vary enormously from country to country, in part because the underlying social welfare system of each country is unique.</p><p>authors: Moran, Donald W</p><p>issue_mesh: Budgets/organization &#x26; administration : Canada : Comparative Study : Cost Control/methods : Data Collection : Europe : Financing, Organized/methods : Health Expenditures/legislation &#x26; jurisprudence : Insurance, Health/economics : Japan : National Health Programs/economics : Reimbursement Mechanisms/economics : Support, U.S. Gov't, Non-P.H.S. : United States</p><p>issue_number: 3</p><p>ntis_number: PB95-111274</p><p>page_range: 55-76</p><p>primary_author: Wolfe, Patrice R</p><p>title: Global budgeting in the OECD countries.</p><p>volume: 14</p><p>year_period: 1993 Spring</p>]]></description></item><item><title>Recent health policy initiatives in Nordic countries.</title><pubDate>Mon, 04 Nov 2019 02:27:10 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191218</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191218</guid><description><![CDATA[<p>abstract: Health care systems in Sweden, Finland, and Denmark are in the midst of substantial organizational reconfiguration. Although retaining their tax-based single source financing arrangements, they have begun experiments that introduce a limited measure of competitive behavior in the delivery of health services. The emphasis has been on restructuring public operated hospitals and health centers into various forms of public firms, rather than on the privatization of ownership of institutions. If successful, the reforms will enable these Nordic countries to combine their existing macroeconomic controls with enhanced microeconomic efficiency, effectiveness, and responsiveness to patients.</p><p>authors: N/A</p><p>issue_mesh: Contract Services : Cost Control : Delivery of Health Care/economics/organization &#x26; administration : Denmark : Economic Competition/organization &#x26; administration : Financing, Organized/methods : Finland : Health Policy/economics/trends : Hospitals, Public/economics/trends : Patient Participation : Physicians/economics : Private Sector : Public Sector : Sweden</p><p>issue_number: 4</p><p>ntis_number: PB2001-105740</p><p>page_range: 157-166</p><p>primary_author: Saltman, Richard B</p><p>title: Recent health policy initiatives in Nordic countries.</p><p>volume: 13</p><p>year_period: 1992 Summer</p>]]></description></item><item><title>Hospital and Medicare financial performance under PPS, 1985-90.</title><pubDate>Mon, 04 Nov 2019 02:27:10 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191248</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191248</guid><description><![CDATA[<p>abstract: Although an increasing number of hospitals are reporting net losses from the Medicare prospective payment system (PPS) for inpatient care, overall hospital facility profit rates remain stable. Hospitals that reported net profits in the Medicare inpatient PPS sector in PPS 7 (1990) had smaller increases in Medicare expenses than hospitals that reported PPS losses in PPS 7. Medicare PPS inpatient net losses in PPS 7 were more than offset by non-Medicare net profits. Even though Medicare PPS revenues grew more slowly than the gross domestic product from 1985 to 1990, other hospital revenues grew more rapidly.</p><p>authors: N/A</p><p>issue_mesh: Data Collection : Diagnosis-Related Groups/economics : Economics, Hospital/statistics &#x26; numerical data/trends : Efficiency : Health Expenditures/statistics &#x26; numerical data : Income/statistics &#x26; numerical data : Medicare/economics/statistics &#x26; numerical data : Patient Discharge/economics : Personnel, Hospital/economics : Prospective Payment System/economics/statistics &#x26; numerical data : Salaries and Fringe Benefits/statistics &#x26; numerical data : United States</p><p>issue_number: 1</p><p>ntis_number: PB95-123279</p><p>page_range: 171-183</p><p>primary_author: Fisher, Charles R</p><p>title: Hospital and Medicare financial performance under PPS, 1985-90.</p><p>volume: 14</p><p>year_period: 1992 Fall</p>]]></description></item><item><title>Allocating practice expense under the Medicare fee schedule.</title><pubDate>Mon, 04 Nov 2019 02:27:10 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191270</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191270</guid><description><![CDATA[<p>abstract: Currently, relative value units for practice expense are determined under the Medicare fee schedule (MFS) using historical physician charges. This seems inconsistent with the goal of a resource-based fee schedule. A specialty resource-based method of determining practice expense payments is presented and simulated here. The method assumes that, for each service, the payment for practice expense should be the same proportion of the total payment as actual physician practice expenses are of total practice revenues. A comparison with the approach developed by the Physician Payment Review Commission (PPRC) shows similar fees, but the specialty-based method proposed here requires no data beyond what is already employed in the MFS.</p><p>authors: Burge, Russel T</p><p>issue_mesh: Relative Value Scales : Comparative Study : Computer Simulation : Cost Allocation/methods : Fee Schedules/economics : Fees, Medical/statistics &#x26; numerical data : Income/statistics &#x26; numerical data : Medicare Part B/economics : Physician Payment Review Commission : Physicians/economics : Practice Management, Medical/economics : Specialties, Medical/economics/statistics &#x26; numerical data : United States</p><p>issue_number: 3</p><p>ntis_number: PB95-111274</p><p>page_range: 139-162</p><p>primary_author: Pope, Gregory C</p><p>title: Allocating practice expense under the Medicare fee schedule.</p><p>volume: 14</p><p>year_period: 1993 Spring</p>]]></description></item><item><title>Americans' health insurance coverage, 1980-91.</title><pubDate>Mon, 04 Nov 2019 02:27:10 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191238</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191238</guid><description><![CDATA[<p>abstract: The authors of this article have used Current Population Surveys to summarize public and private health insurance trends in the United States over the last 12 years. Key findings include the declining percentage of the non-elderly population with employer-sponsored coverage and increasing numbers of low- and middle-income uninsured. That is, in a period of fast-rising health care costs, the poor and the near-poor in working families have been losing coverage for health care and facing increasing risks of inadequate care and financial loss. These data highlight health care access and financing problems now facing the Nation.</p><p>authors: Letsch, Suzanne W; Olin, Gary L</p><p>issue_mesh: Adolescence : Adult : Age Factors : Aged : Child : Child, Preschool : Data Collection : Health Benefit Plans, Employee/statistics &#x26; numerical data : Human : Income/statistics &#x26; numerical data : Industry/statistics &#x26; numerical data : Infant : Infant, Newborn : Insurance, Health/statistics &#x26; numerical data : Medicaid/statistics &#x26; numerical data : Medically Uninsured/statistics &#x26; numerical data : Medicare/statistics &#x26; numerical data : Middle Age : Socioeconomic Factors : United States</p><p>issue_number: 1</p><p>ntis_number: PB95-123279</p><p>page_range: 31-57</p><p>primary_author: Levit, Katharine R</p><p>title: Americans' health insurance coverage, 1980-91.</p><p>volume: 14</p><p>year_period: 1992 Fall</p>]]></description></item><item><title>Preventive health care in six countries: models for reform?</title><pubDate>Mon, 04 Nov 2019 02:27:10 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191320</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191320</guid><description><![CDATA[<p>abstract: International systems are frequently offered as models for health care reform. This study, focusing on preventive services for children and pregnant women in six industrialized countries, finds that a broad range of preventive services can be provided through health care systems with divergent financing and cost containment, utilizing multiple entry points into the health care system, and employing targeted programs for high-risk patients. Despite variability in form and financing, health outcomes are not compromised, suggesting that health care reformers in this country need not be restricted to any single model to strengthen preventive health care for children and pregnant women.</p><p>authors: N/A</p><p>issue_mesh: Models, Organizational : Canada : Child : Child Health Services/organization &#x26; administration/statistics &#x26; numerical data : Comparative Study : Data Collection : Female : Financing, Organized : France : Germany : Great Britain : Health Expenditures/statistics &#x26; numerical data : Health Services Accessibility : Health Services Research : Human : Insurance, Health : Japan : Pregnancy : Prenatal Care/organization &#x26; administration/statistics &#x26; numerical data : Preventive Health Services/organization &#x26; administration/statistics &#x26; numerical data : Sweden : United States</p><p>issue_number: 4</p><p>ntis_number: PB99-106437</p><p>page_range: 7-19</p><p>primary_author: Chaulk, C Patrick</p><p>title: Preventive health care in six countries: models for reform?</p><p>volume: 15</p><p>year_period: 1994 Summer</p>]]></description></item><item><title>Health care indicators</title><pubDate>Mon, 04 Nov 2019 02:27:10 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191274</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191274</guid><description><![CDATA[<p>authors: Levit, Katharine R; Maple, Brenda T</p><p>issue_mesh: Budgets/legislation &#x26; jurisprudence : Deductibles and Coinsurance/legislation &#x26; jurisprudence : Economics, Hospital/legislation &#x26; jurisprudence : Education, Medical, Graduate/economics : Health Maintenance Organizations/economics/legislation &#x26; jurisprudence : Insurance, Health, Reimbursement/legislation &#x26; jurisprudence : Medicaid/legislation &#x26; jurisprudence : Medicare Part A/legislation &#x26; jurisprudence : Medicare Part B/legislation &#x26; jurisprudence : Medicare/legislation &#x26; jurisprudence : United States</p><p>issue_number: 3</p><p>ntis_number: PB95-111274</p><p>page_range: 249-282</p><p>primary_author: Donham, Carolyn S</p><p>title: Health care indicators</p><p>volume: 14</p><p>year_period: 1993 Spring</p>]]></description></item><item><title>Medicaid recipients, services, utilization, and program payments.</title><pubDate>Mon, 04 Nov 2019 02:27:10 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191236</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191236</guid><description><![CDATA[<p>ntis_number: PB99-106460</p><p>page_range: 311-336</p><p>primary_author: Silverman, Herbert A</p><p>title: Medicaid recipients, services, utilization, and program payments.</p><p>volume: Supp.</p><p>year_period: 1992 Supp.</p>]]></description></item><item><title>Do health maintenance organizations work for Medicare?</title><pubDate>Mon, 04 Nov 2019 02:27:10 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191288</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191288</guid><description><![CDATA[<p>abstract: Since 1985, the Health Care Financing Administration (HCFA) has encouraged health maintenance organizations (HMOs) to provide Medicare coverage to enrolled beneficiaries for fixed prepaid premiums. Our evaluation shows that the risk program achieves some of its goals while not fulfilling others. We find that HMOs provide care of comparable quality to that delivered by free-for-service (FFS) providers using fewer health care resources. Enrollees experience substantially reduced out-of-pocket costs and greater coverage. However, because the capitation system does not account for the better health of those who enroll, the program does not save money for Medicare.</p><p>authors: Bergeron, Jeanette W; Clement, Delores G; Hill, Jerrold W; Retchin, Sheldon M</p><p>issue_mesh: Capitation Fee : Comparative Study : Consumer Satisfaction : Cost Savings/methods : Data Collection : Health Maintenance Organizations/economics/statistics &#x26; numerical data/utilization : Hospitals/utilization : Medicare/organization &#x26; administration : Program Evaluation/economics/statistics &#x26; numerical data : Risk : Support, U.S. Gov't, Non-P.H.S. : Treatment Outcome : United States : United States Health Care Financing Administration</p><p>issue_number: 1</p><p>ntis_number: PB95-123493</p><p>page_range: 7-23</p><p>primary_author: Brown, Randall S</p><p>title: Do health maintenance organizations work for Medicare?</p><p>volume: 15</p><p>year_period: 1993 Fall</p>]]></description></item><item><title>Are PPS payments adequate? Issues for updating and assessing rates.</title><pubDate>Mon, 04 Nov 2019 02:27:10 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191260</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191260</guid><description><![CDATA[<p>abstract: Declining operating margins under Medicare's prospective payment system (PPS) have focused attention on the adequacy of payment rates. The question of whether annual updates to the rates have been too low or cost increases too high has become important. In this article we discuss issues relevant to updating PPS rates and judging their adequacy. We describe a modification to the current framework for recommending annual update factors. This framework is then used to retrospectively assess PPS payment and cost growth since 1985. The preliminary results suggest that current rates are more than adequate to support the cost of efficient care. Also discussed are why using financial margins to evaluate rates is problematic and alternative methods that might be employed.</p><p>authors: Richter, Elizabeth</p><p>issue_mesh: Diagnosis-Related Groups/economics : Economics, Hospital/statistics &#x26; numerical data/trends : Efficiency : Health Care Costs/trends : Medicare/economics/statistics &#x26; numerical data : Prospective Payment System/standards : Rate Setting and Review/methods : United States</p><p>issue_number: 2</p><p>ntis_number: PB2001-105739</p><p>page_range: 165-175</p><p>primary_author: Sheingold, Steven H</p><p>title: Are PPS payments adequate? Issues for updating and assessing rates.</p><p>volume: 14</p><p>year_period: 1992 Winter</p>]]></description></item><item><title>Health care indicators</title><pubDate>Mon, 04 Nov 2019 02:27:10 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191286</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191286</guid><description><![CDATA[<p>authors: Letsch, Suzanne W; Maple, Brenda T</p><p>issue_mesh: Budgets/legislation &#x26; jurisprudence : Deductibles and Coinsurance/legislation &#x26; jurisprudence : Economics, Hospital/legislation &#x26; jurisprudence : Education, Medical, Graduate/economics : Health Maintenance Organizations/economics/legislation &#x26; jurisprudence : Insurance, Health, Reimbursement/legislation &#x26; jurisprudence : Medicaid/legislation &#x26; jurisprudence : Medicare Part A/legislation &#x26; jurisprudence : Medicare Part B/legislation &#x26; jurisprudence : Medicare/legislation &#x26; jurisprudence : United States</p><p>issue_number: 4</p><p>ntis_number: PB95-123485</p><p>page_range: 209-238</p><p>primary_author: Donham, Carolyn S</p><p>title: Health care indicators</p><p>volume: 14</p><p>year_period: 1993 Summer</p>]]></description></item><item><title>A description of Medicaid eligibility.</title><pubDate>Mon, 04 Nov 2019 02:27:10 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191230</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191230</guid><description><![CDATA[<p>ntis_number: PB99-106460</p><p>page_range: 207-225</p><p>primary_author: Gurny, Paul</p><p>title: A description of Medicaid eligibility.</p><p>volume: Supp.</p><p>year_period: 1992 Supp.</p>]]></description></item><item><title>Analysis of underwriting factors for AAPCC (adjusted average per capita cost).</title><pubDate>Mon, 04 Nov 2019 02:27:10 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191244</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191244</guid><description><![CDATA[<p>abstract: The adjusted average per capita cost (AAPCC) formula is used to determine payment to health maintenance organizations (HMOs) by Medicare. The four original underwriting factors (i.e., age, sex, institutional status, and welfare status) for the AAPCC were calibrated from the Current Medicare Surveys for 1974-76. Those factors have been updated by various actuarial adjustments. Revised calculations of the AAPCC underwriting factors are presented using survey data from the 1984 National Long-Term Care Survey and expenditure data from the Medicare Part A and Part B bill files. Also examined is the effect on the underwriting factors of chronic functional disability, defined as having one or more chronic limitations in activities of daily living. Comparison of alternative underwriting factors is conducted by simulating the dollar impact on payment to HMOs for select enrollee populations.</p><p>authors: Stallard, Eric</p><p>issue_mesh: Actuarial Analysis : Aged : Computer Simulation : Costs and Cost Analysis/statistics &#x26; numerical data : Disabled Persons/statistics &#x26; numerical data : Female : Health Maintenance Organizations/economics : Health Status Indicators : Human : Institutionalization/economics : Male : Medicare Part A/economics/statistics &#x26; numerical data : Medicare Part B/economics/statistics &#x26; numerical data : Prospective Payment System/statistics &#x26; numerical data : Socioeconomic Factors : Support, U.S. Gov't, Non-P.H.S. : Support, U.S. Gov't, P.H.S. : United States</p><p>issue_number: 1</p><p>ntis_number: PB95-123279</p><p>page_range: 117-132</p><p>primary_author: Manton, Kenneth G</p><p>title: Analysis of underwriting factors for AAPCC (adjusted average per capita cost).</p><p>volume: 14</p><p>year_period: 1992 Fall</p>]]></description></item><item><title>Outcomes of California's Medicaid cost-containment policies, 1981-84.</title><pubDate>Mon, 04 Nov 2019 02:27:10 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191240</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191240</guid><description><![CDATA[<p>abstract: In 1982, California enacted a package of tough Medicaid cost-containment measures. This article examines its effects on program expenditures through 1984 by enrollment group and service category. Total expenditures fell by 19 percent (or $656.5 million) after inflation. Expenditures per enrollee declined for almost every group, with enrollees on cash assistance taking the greatest reductions. Ambulatory, physician, and pharmacy spending declined the most followed by long-term and hospital care. The effects of these policies are of particular importance in the early 1990s as States face even greater fiscal challenges and seek lessons from past attempts at controlling program costs.</p><p>authors: Baugh, David K; McDevitt, Roland D; Ruther, Martin M</p><p>issue_mesh: California : Cost Control/statistics &#x26; numerical data/standards : Data Collection : Evaluation Studies : Health Expenditures/statistics &#x26; numerical data : Health Policy/legislation &#x26; jurisprudence : Medicaid/economics/organization &#x26; administration : State Health Plans/economics : United States</p><p>issue_number: 1</p><p>ntis_number: PB95-123279</p><p>page_range: 65-78</p><p>primary_author: Preston, Bonnie J</p><p>title: Outcomes of California's Medicaid cost-containment policies, 1981-84.</p><p>volume: 14</p><p>year_period: 1992 Fall</p>]]></description></item><item><title>Measuring inpatient and outpatient costs: a cost-function approach.</title><pubDate>Mon, 04 Nov 2019 02:27:10 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191256</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191256</guid><description><![CDATA[<p>abstract: In this article, the authors estimate a multiple-output cost function for a sample of 2,235 hospitals during the period 1984-88 to disaggregate total costs into inpatient and outpatient components. The results suggest that outpatient cost growth is roughly proportional to that of inpatient cost, despite much higher relative growth in revenues and utilization on the outpatient side. The stability in the outpatient/inpatient cost ratio implies that the increase in the outpatient-to-inpatient utilization ratio was offset by a decline in their relative unit costs.</p><p>authors: Stefos, Theodore</p><p>issue_mesh: Comparative Study : Cost Allocation/methods/statistics &#x26; numerical data : Data Collection : Hospitalization/economics : Inpatients/statistics &#x26; numerical data : Medicare/economics : Models, Statistical : Outpatient Clinics, Hospital/economics : Outpatients/statistics &#x26; numerical data : Prospective Payment System/economics : Regression Analysis : United States</p><p>issue_number: 2</p><p>ntis_number: PB2001-105739</p><p>page_range: 115-124</p><p>primary_author: Carey, Kathleen</p><p>title: Measuring inpatient and outpatient costs: a cost-function approach.</p><p>volume: 14</p><p>year_period: 1992 Winter</p>]]></description></item><item><title>Medicare supplementary medical insurance benefit for hospital outpatient services.</title><pubDate>Mon, 04 Nov 2019 02:27:10 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191228</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191228</guid><description><![CDATA[<p>ntis_number: PB99-106460</p><p>page_range: 183-197</p><p>primary_author: Petrie, John T</p><p>title: Medicare supplementary medical insurance benefit for hospital outpatient services.</p><p>volume: Supp.</p><p>year_period: 1992 Supp.</p>]]></description></item><item><title>Hospital insurance short-stay hospital benefits.</title><pubDate>Mon, 04 Nov 2019 02:27:10 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191224</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191224</guid><description><![CDATA[<p>ntis_number: PB99-106460</p><p>page_range: 55-96</p><p>primary_author: Helbing, Charles</p><p>title: Hospital insurance short-stay hospital benefits.</p><p>volume: Supp.</p><p>year_period: 1992 Supp.</p>]]></description></item><item><title>Assessing cost effects of nursing-home-based geriatric nurse practitioners.</title><pubDate>Mon, 04 Nov 2019 02:27:08 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191095</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191095</guid><description><![CDATA[<p>abstract: Employment of geriatric nurse practitioners (GNPs) is one strategy to improve nursing home care. The effects of GNPs on costs and profitability of nursing homes and on costs of patient medical service use outside the nursing home are examined. Employment of GNPs does not adversely affect nursing home costs or significantly affect profits. There is some evidence of cost savings in medical service use for newly admitted patients but no evidence of savings for continuing residents. GNPs reduce the use of hospital services for both groups, and the reduction is statistically significant for newly admitted patients.</p><p>authors: Arnold, Sharon B; Bell, Robert M; Garrard, Judith; Kane, Robert L; Witsberger, Christina J</p><p>issue_mesh: Aged : Analysis of Variance : Costs and Cost Analysis : Data Collection : Education, Nursing, Continuing : Employment/statistics &#x26; numerical data : Evaluation Studies : Geriatric Nursing/manpower : Health Expenditures/statistics &#x26; numerical data : Human : Nurse Practitioners/utilization : Nursing Homes/economics : Support, Non-U.S. Gov't : Support, U.S. Gov't, Non-P.H.S. : United States</p><p>issue_number: 3</p><p>ntis_number: PB90-258153</p><p>page_range: 67-78</p><p>primary_author: Buchanan, Joan L</p><p>title: Assessing cost effects of nursing-home-based geriatric nurse practitioners.</p><p>volume: 11</p><p>year_period: 1990 Spring</p>]]></description></item><item><title>Prescription drug payment policy: past, present, and future.</title><pubDate>Mon, 04 Nov 2019 02:27:08 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191308</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191308</guid><description><![CDATA[<p>abstract: The articles presented in this issue offer an array of policy-relevant studies in an area that has become increasingly important to both the public and third-party payers. Although it is believed that appropriate utilization of drugs can contribute to containing the growth of health care costs, the impact of appropriate prescribing, dispensing, and use of drugs associated with costs of hospitalizations and physician visits is generally unavailable. As new, ever-more-expensive drugs come to market, comprehensive studies of utilization, expenditures, prices, quality, and cost effectiveness will enhance the policy process.</p><p>authors: N/A</p><p>issue_mesh: Health Care Reform/economics : Health Policy/economics/trends : Insurance, Pharmaceutical Services/trends : Medicaid : Medicare : Prescription Fees : Reimbursement Mechanisms : State Health Plans : United States</p><p>issue_number: 3</p><p>ntis_number: PB95-123477</p><p>page_range: 1-7</p><p>primary_author: Gondek, Kathleen E</p><p>title: Prescription drug payment policy: past, present, and future.</p><p>volume: 15</p><p>year_period: 1994 Spring</p>]]></description></item><item><title>Resident medical care utilization patterns in continuing care retirement communities.</title><pubDate>Mon, 04 Nov 2019 02:27:08 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191284</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191284</guid><description><![CDATA[<p>abstract: This article presents the findings of an evaluation of medical care service utilization by two elderly cohorts: one living in continuing care retirement communities (CCRCs) and the other living in traditional community settings. CCRC residents' overall use of Medicare-covered medical services did not differ significantly from that of the traditional community-residing elders. Both groups incurred annual per capita expenditures of approximately $2,000. In their last year of life, however, CCRC residents displayed significantly lower expenditures for hospital care ($3,854 versus $7,268) but higher expenditures for Medicare or non-Medicare-covered nursing home care ($5,565 versus $3,533).</p><p>authors: Morris, John N; Morris, Shirley</p><p>issue_mesh: Aged : Comparative Study : Data Collection : Female : Health Expenditures/statistics &#x26; numerical data : Housing for the Elderly/economics : Human : Medicare/statistics &#x26; numerical data/utilization : Multivariate Analysis : Residence Characteristics : Support, U.S. Gov't, Non-P.H.S. : United States : Utilization Review/statistics &#x26; numerical data</p><p>issue_number: 4</p><p>ntis_number: PB95-123485</p><p>page_range: 151-168</p><p>primary_author: Ruchlin, Hirsch H</p><p>title: Resident medical care utilization patterns in continuing care retirement communities.</p><p>volume: 14</p><p>year_period: 1993 Summer</p>]]></description></item><item><title>The changing face of long-term care.</title><pubDate>Mon, 04 Nov 2019 02:27:08 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191276</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191276</guid><description><![CDATA[<p>abstract: In this article, we present population estimates of individuals with disabilities and discuss the manner in which the composition of this population is changing. We then highlight aspects of service delivery systems that are evolving in response to the changing long-term care (LTC) population. Following a summary of financing issues, we discuss several cross-cutting issues related to the organization of service delivery, quality assurance (QA), and financing. Current and future Health Care Financing Administration (HCFA) research and demonstrations emerging from these issues are then described.</p><p>authors: Clauser, Steven B; Miller, Nancy A</p><p>issue_mesh: Chronic Disease/economics/therapy : Comprehensive Health Care/organization &#x26; administration : Demography : Disabled Persons/statistics &#x26; numerical data : Financing, Government : Forecasting : Health Expenditures/trends : Health Services Needs and Demand/trends : Health Services Research/organization &#x26; administration : Human : Insurance, Long-Term Care : Long-Term Care/economics/standards/trends : Medicaid/statistics &#x26; numerical data/utilization : Medicare/statistics &#x26; numerical data/utilization : Pilot Projects : United States</p><p>issue_number: 4</p><p>ntis_number: PB95-123485</p><p>page_range: 5-24</p><p>primary_author: Vladeck, Bruce C</p><p>title: The changing face of long-term care.</p><p>volume: 14</p><p>year_period: 1993 Summer</p>]]></description></item><item><title>International pharmaceutical spending controls: France, Germany, Sweden, and the United Kingdom.</title><pubDate>Mon, 04 Nov 2019 02:27:08 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191316</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191316</guid><description><![CDATA[<p>abstract: France, Germany, Sweden, and the United Kingdom each use different types of policies for controlling prescription drug spending. Until recent years, these policies have relied heavily on regulating prices charged by drug manufacturers, with different systems providing varying degrees of pricing freedom. While these policies appear to have brought some degree of price restraint, they have not prevented continued growth in prescription drug spending. As a result, each country is supplementing its policies with measures aimed at physicians and consumers and targeted at reducing a perceived over-utilization of pharmaceutical products.</p><p>authors: Glavin, Sarah L; Perez, James; Ratner, Jonathan</p><p>issue_mesh: Comparative Study : Cost Control/legislation &#x26; jurisprudence : Cost Sharing : Drug Costs/legislation &#x26; jurisprudence : Drug Industry/economics/legislation &#x26; jurisprudence : Drug Utilization/trends : Eligibility Determination : France : Germany : Great Britain : Health Policy/economics/legislation &#x26; jurisprudence : Inflation, Economic/trends : Insurance, Pharmaceutical Services/utilization : National Health Programs/economics : State Medicine/economics</p><p>issue_number: 3</p><p>ntis_number: PB95-123477</p><p>page_range: 127-140</p><p>primary_author: Gross, David J</p><p>title: International pharmaceutical spending controls: France, Germany, Sweden, and the United Kingdom.</p><p>volume: 15</p><p>year_period: 1994 Spring</p>]]></description></item><item><title>Overview: Hospital payment: Beyond the prospective payment system.</title><pubDate>Mon, 04 Nov 2019 02:27:08 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191296</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191296</guid><description><![CDATA[<p>authors: N/A</p><p>issue_mesh: Tax Equity and Fiscal Responsibility Act : Cost Sharing/methods : Health Services Research : Hospital Costs/statistics &#x26; numerical data : Hospital Units/economics : Hospitals, Special/economics/legislation &#x26; jurisprudence/statistics &#x26; numerical data : Income/statistics &#x26; numerical data : Insurance, Health, Reimbursement/statistics &#x26; numerical data : Medicare Part A/legislation &#x26; jurisprudence/statistics &#x26; numerical data : Ownership/economics : United States</p><p>issue_number: 2</p><p>ntis_number: PB95-123469</p><p>page_range: 1-5</p><p>primary_author: Saunders, William D</p><p>title: Overview: Hospital payment: Beyond the prospective payment system.</p><p>volume: 15</p><p>year_period: 1993 Winter</p>]]></description></item><item><title>Access and use of health services by chronically mentally ill Medicaid beneficiaries.</title><pubDate>Mon, 04 Nov 2019 02:27:08 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191280</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191280</guid><description><![CDATA[<p>abstract: This article has two objectives: to quantify the access and utilization of services received by chronically mentally ill Medicaid recipients, and to compare service utilization and access under prepayment and fee-for-service (FFS) payment. The study setting is Hennepin County (Minneapolis), Minnesota, where 35 percent of Medicaid recipients were randomly assigned to receive services from prepaid plans. An algorithm was developed to identify recipients with chronic mental illness, resulting in 739 study participants, split approximately evenly between prepayment and FFS Medicaid. Data were collected through in-person surveys at baseline, and after 1 year. We found slight improvements in the majority of access measures studied and no significant decreases in the use of inpatient or outpatient services for enrollees in prepaid health plans. The results support efforts to expand the use of prepaid health plans to meet the needs of non-institutionalized chronically mentally ill Medicaid beneficiaries.</p><p>authors: Akhtar, Muhammad R; Christianson, Jon B; Finch, Michael; Lurie, Nicole; Popkin, Michael</p><p>issue_mesh: Adult : Algorithms : Ambulatory Care/utilization : Chronic Disease/economics/therapy : Community Mental Health Services/utilization : Comparative Study : Data Collection : Fees, Medical : Health Services Accessibility/statistics &#x26; numerical data : Human : Institutionalization : Male : Medicaid/utilization : Mental Disorders/economics/therapy : Middle Age : Minnesota : Multivariate Analysis : Prepaid Health Plans/utilization : Regression Analysis : Support, Non-U.S. Gov't : Support, U.S. Gov't, P.H.S. : United States : Utilization Review/statistics &#x26; numerical data</p><p>issue_number: 4</p><p>ntis_number: PB95-123485</p><p>page_range: 75-87</p><p>primary_author: Moscovice, Ira S</p><p>title: Access and use of health services by chronically mentally ill Medicaid beneficiaries.</p><p>volume: 14</p><p>year_period: 1993 Summer</p>]]></description></item><item><title>Lessons for states in inpatient ratesetting under the Boren Amendment.</title><pubDate>Mon, 04 Nov 2019 02:27:08 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191304</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191304</guid><description><![CDATA[<p>abstract: Encouraged by a 1990 Supreme Court decision, Medicaid providers have challenged State inpatient ratesetting methodologies under the Boren Amendment. Procedurally, State assurances to the U.S. Department of Health and Human Services (DHHS) that payment rates meet the Amendment's requirements must be supported by findings based on a reasonably principled analysis. Substantively, rates may fall within a zone of reasonableness, but courts have differed in interpreting and applying the Amendment's terms. Although some courts have found special studies and written findings unnecessary, States that undertake economic analyses to support their findings are more likely to withstand judicial scrutiny. Several applicable economic analyses are proposed.</p><p>authors: Gabay, Mary; Gaumer, Gary L; Ozminkowski, Ronald J</p><p>issue_mesh: Cost Control/legislation &#x26; jurisprudence : Efficiency, Organizational/economics : Financial Management, Hospital/legislation &#x26; jurisprudence : Health Services Research : Hospital Costs/legislation &#x26; jurisprudence : Insurance, Health, Reimbursement/legislation &#x26; jurisprudence : Medicaid/economics/legislation &#x26; jurisprudence : Rate Setting and Review/legislation &#x26; jurisprudence/methods/standards : Regression Analysis : Residential Facilities/economics/legislation &#x26; jurisprudence : State Health Plans/economics/legislation &#x26; jurisprudence : United States : United States Health Care Financing Administration</p><p>issue_number: 2</p><p>ntis_number: PB95-123469</p><p>page_range: 137-154</p><p>primary_author: Batavia, Andrew I</p><p>title: Lessons for states in inpatient ratesetting under the Boren Amendment.</p><p>volume: 15</p><p>year_period: 1993 Winter</p>]]></description></item><item><title>Risk adjustment for a children's capitation rate.</title><pubDate>Mon, 04 Nov 2019 02:27:08 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191290</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191290</guid><description><![CDATA[<p>abstract: Few capitation arrangements vary premiums by a child's health characteristics, yielding an incentive to discriminate against children with predictably high expenditures from chronic diseases. In this article, we explore risk adjusters for the 35 percent of the variance in annual out-patient expenditure we find to be potentially predictable. Demographic factors such as age and gender only explain 5 percent of such variance; health status measures explain 25 percent, prior use and health status measures together explain 65 to 70 percent. The profit from risk selection falls less than proportionately with improved ability to adjust for risk. Partial capitation rates may be necessary to mitigate skimming and dumping.</p><p>authors: Keeler, Emmett B; Manning Jr, Willard G; Sloss, Elizabeth M</p><p>issue_mesh: Capitation Fee : Ambulatory Care/economics/statistics &#x26; numerical data : Analysis of Variance : Child : Child Health Services/economics/utilization : Data Collection : Health Expenditures/statistics &#x26; numerical data : Health Maintenance Organizations/economics/utilization : Health Services Research : Health Status Indicators : Human : Income/statistics &#x26; numerical data : Medicare/organization &#x26; administration : Models, Statistical : Rate Setting and Review/methods : Risk : Support, U.S. Gov't, Non-P.H.S. : United States</p><p>issue_number: 1</p><p>ntis_number: PB95-123493</p><p>page_range: 39-54</p><p>primary_author: Newhouse, Joseph P</p><p>title: Risk adjustment for a children's capitation rate.</p><p>volume: 15</p><p>year_period: 1993 Fall</p>]]></description></item><item><title>Medicare dependent hospitals: who depends on whom?</title><pubDate>Mon, 04 Nov 2019 02:27:08 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191254</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191254</guid><description><![CDATA[<p>abstract: Small rural hospitals with a large proportion of Medicare patients currently receive special treatment as Medicare dependent hospitals (MDHs) under the prospective payment system (PPS). Other high Medicare hospitals (HMHs)--both urban and rural--have sought to have the additional per case payments extended to them. Current utilization patterns, the availability of alternative facilities, and the socioeconomic and demographic characteristics of the service areas were examined to determine whether either the current MDH or alternative HMH targeting criteria identify hospitals whose closure might impair access to care for Medicare beneficiaries residing in their service areas. Neither MDHs nor HMHs are substantially different from other hospitals in terms of providing access. While some individual MDHs or HMHs might be considered essential access facilities, alternate criteria should be developed to identify these facilities regardless of the proportion of their patients attributable to the Medicare program.</p><p>authors: N/A</p><p>issue_mesh: Catchment Area (Health)/economics : Comparative Study : Health Services Accessibility/standards : Hospitals, Rural/economics/utilization : Hospitals, Urban/economics/utilization : Medicare Part A/statistics &#x26; numerical data/utilization : Prospective Payment System/standards : Rate Setting and Review/methods : United States</p><p>issue_number: 2</p><p>ntis_number: PB2001-105739</p><p>page_range: 97-105</p><p>primary_author: Goody, Brigid</p><p>title: Medicare dependent hospitals: who depends on whom?</p><p>volume: 14</p><p>year_period: 1992 Winter</p>]]></description></item><item><title>Medicare prospective payment without separate urban and rural rates.</title><pubDate>Mon, 04 Nov 2019 02:27:08 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191250</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191250</guid><description><![CDATA[<p>abstract: The elimination of urban-rural differences in the Medicare prospective payment system (PPS) standard rates implies a need to re-examine all the PPS payment adjustments. Refinements for case mix, outliers, and the wage index can make a significant contribution to avoiding payment disparities in a single-rate system. However, changes in the adjustments for teaching and disproportionate-share (DSH) hospitals are also needed. The typically urban location of these hospitals makes it difficult to balance PPS payments and costs among major groups of urban and rural hospitals without some form of higher payment for all hospitals located in large urban areas.</p><p>authors: Ault, Thomas; Cotterill, Philip G; DeLew, Nancy; Phillips, Steven M; Richter, Elizabeth; Wynn, Barbara</p><p>issue_mesh: Diagnosis-Related Groups/economics : Hospitals, Rural/economics : Hospitals, Teaching/economics : Hospitals, Urban/economics : Medicare Part A/economics/statistics &#x26; numerical data : Outliers, DRG/economics : Prospective Payment System/standards : Rate Setting and Review/standards : Regression Analysis : United States</p><p>issue_number: 2</p><p>ntis_number: PB2001-105739</p><p>page_range: 31-47</p><p>primary_author: O'Dougherty, Sheila M</p><p>title: Medicare prospective payment without separate urban and rural rates.</p><p>volume: 14</p><p>year_period: 1992 Winter</p>]]></description></item><item><title>Comparing physician fee schedules in Canada and the United States.</title><pubDate>Mon, 04 Nov 2019 02:27:08 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191246</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191246</guid><description><![CDATA[<p>abstract: Although Canada and the United States have fundamentally different systems for financing health care, there are many similarities between the two countries in their approaches to physician payment. The similarities have increased recently with the adoption of the Medicare fee schedule. Canadian provinces have been using fee schedules for more than 20 years. This article provides an overview of the fee schedules used by Medicare and the four largest Canadian provinces, highlighting specific similarities and differences. We conclude that, although some differences in service definitions exist, the major areas of contrast relate to what services are paid for and how fees are updated. Updating fees is important because it affects how rapidly expenditures grow.</p><p>authors: Welch, W Pete; Zuckerman, Stephen</p><p>issue_mesh: Canada : Comparative Study : Fee Schedules/organization &#x26; administration : Insurance, Physician Services/economics : Medicare Part B/economics : National Health Programs/economics : Rate Setting and Review/organization &#x26; administration : Relative Value Scales : Support, Non-U.S. Gov't : Support, U.S. Gov't, Non-P.H.S. : United States</p><p>issue_number: 1</p><p>ntis_number: PB95-123279</p><p>page_range: 141-149</p><p>primary_author: Katz, Steven J</p><p>title: Comparing physician fee schedules in Canada and the United States.</p><p>volume: 14</p><p>year_period: 1992 Fall</p>]]></description></item><item><title>Disabled workers' risk of hospitalization and death.</title><pubDate>Mon, 04 Nov 2019 02:27:08 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191324</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191324</guid><description><![CDATA[<p>abstract: Data from the 1982 New Beneficiary Survey (NBS) were matched with 5 years (1984-88) of Social Security and Medicare data to analyze disabled workers' probability of death and inpatient care. Fifteen percent of the disabled workers died within 18-24 months of initial eligibility; 34 percent died within 5 years. Older disabled workers had higher probabilities of death and hospitalization. Males were two times as likely to die as females, but no more likely to be hospitalized. Black persons also had a higher risk of death but no greater risk of hospitalization than other races. Additional health insurance had no influence on survival, but was differentially associated with inpatient care. Married males were more likely to survive. Physical functioning capacity had no influence on survival or hospitalization. Respiratory, circulatory, and digestive disorders increased the probability of hospitalization and mortality.</p><p>authors: Iams, Howard M</p><p>issue_mesh: Risk Assessment : Age Factors : Aged : Blacks : Comparative Study : Data Collection : Disabled Persons/statistics &#x26; numerical data : Eligibility Determination : Female : Health Status Indicators : Hospitalization/statistics &#x26; numerical data : Human : Logistic Models : Male : Middle Age : Sex Factors : Social Security/utilization : Socioeconomic Factors : Survival Rate : United States : Whites</p><p>issue_number: 4</p><p>ntis_number: PB99-106437</p><p>page_range: 61-76</p><p>primary_author: McCoy, John L</p><p>title: Disabled workers' risk of hospitalization and death.</p><p>volume: 15</p><p>year_period: 1994 Summer</p>]]></description></item><item><title>Rural and urban differentials in Medicare home health use.</title><pubDate>Mon, 04 Nov 2019 02:27:08 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191278</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191278</guid><description><![CDATA[<p>abstract: This article addresses whether the use of Medicare home health services differs systematically for rural and urban beneficiaries. It draws on Medicare data bases from 1983, 1985, and 1987, including the Health Insurance Skeleton Write-Off (HISKEW) files and the Home Health Agency (HHA) 40-percent Bill Skeleton files. It presents background information on rural and urban beneficiaries and contrasts the use rates, visit levels and profiles, episodes of home health use, and primary diagnoses in rural and urban areas. The results point to higher home health use rates in urban areas and to a narrowing of the urban-rural use differential from 1983 to 1987. Rural home health users receive on average three more visits than their urban counterparts, with many more skilled nursing and home health aide visits. However, rural enrollees are much less likely than urban enrollees to receive medical social service or therapeutic visits, even after controlling for primary diagnosis. These findings point to the need for further analysis to understand the consequences of these differences.</p><p>authors: N/A</p><p>issue_mesh: Comparative Study : Data Collection : Diagnosis-Related Groups/statistics &#x26; numerical data : Episode of Care : Geography : Home Care Services/economics/utilization : Human : Medicare/statistics &#x26; numerical data/utilization : Rural Health/statistics &#x26; numerical data : United States : Urban Health/statistics &#x26; numerical data : Utilization Review/statistics &#x26; numerical data</p><p>issue_number: 4</p><p>ntis_number: PB95-123485</p><p>page_range: 39-57</p><p>primary_author: Kenney, Genevieve M</p><p>title: Rural and urban differentials in Medicare home health use.</p><p>volume: 14</p><p>year_period: 1993 Summer</p>]]></description></item><item><title>Health care indicators.</title><pubDate>Mon, 04 Nov 2019 02:27:08 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191164</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191164</guid><description><![CDATA[<p>authors: Letsch, Suzanne W; Levit, Katharine R; Maple, Brenda T; Stewart, Madie W</p><p>issue_mesh: Economics/statistics &#x26; numerical data : Employment/statistics &#x26; numerical data : Health Manpower/statistics &#x26; numerical data : Home Care Services/economics : Hospitals, Community/statistics &#x26; numerical data : Prospective Payment System/statistics &#x26; numerical data : Skilled Nursing Facilities/economics : United States</p><p>issue_number: 3</p><p>ntis_number: PB91-201384</p><p>page_range: 121-140</p><p>primary_author: Cowan, Cathy A</p><p>title: Health care indicators.</p><p>volume: 12</p><p>year_period: 1991 Spring</p>]]></description></item><item><title>Monitoring access following Medicare price changes: physician perspective.</title><pubDate>Mon, 04 Nov 2019 02:27:08 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191268</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191268</guid><description><![CDATA[<p>abstract: In this article, the author examines changes in Medicare beneficiaries' access to services following the Omnibus Budget Reconciliation Act of 1987 "overpriced" procedure price reductions from the physician perspective. Three measures of physician availability remained essentially constant: number of physicians treating beneficiaries or performing overpriced procedures; average Medicare caseload; and average share of a physician's Medicare practice comprised of those who are poor and not white. Physician practice characteristics were examined and provided evidence of continuing participation in Medicare: Average Medicare revenue increased 10 percent, and average volume of all services increased. However, physicians with the largest fee reductions or who were the most financially dependent on the procedures did not change overpriced procedure volume.</p><p>authors: N/A</p><p>issue_mesh: Analysis of Variance : Fee Schedules : Health Services Accessibility/economics : Medicare Assignment/statistics &#x26; numerical data : Medicare Part B/economics/utilization : Physicians/classification/economics : Program Evaluation/statistics &#x26; numerical data : Rate Setting and Review : Relative Value Scales : United States : Workload/statistics &#x26; numerical data</p><p>issue_number: 3</p><p>ntis_number: PB95-111274</p><p>page_range: 97-117</p><p>primary_author: McCall, Nancy T</p><p>title: Monitoring access following Medicare price changes: physician perspective.</p><p>volume: 14</p><p>year_period: 1993 Spring</p>]]></description></item><item><title>Health care indicators</title><pubDate>Mon, 04 Nov 2019 02:27:08 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191318</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191318</guid><description><![CDATA[<p>abstract: This regular feature of the journal includes a discussion of each of the following four topics: community hospital statistics; employment, hours, and earnings in the private health sector; health care prices; and national economic indicators. These statistics are valuable in their own right for understanding the relationship between the health care sector and the overall economy. In addition, they allow us to anticipate the direction and magnitude of health care cost changes prior to the availability of more comprehensive data.</p><p>authors: Maple, Brenda T; Sensenig, Arthur L</p><p>issue_mesh: Data Collection : Employment/statistics &#x26; numerical data/trends : Health Care Sector/statistics &#x26; numerical data : Health Expenditures/statistics &#x26; numerical data/trends : Health Personnel/economics : Hospitals, Community/statistics &#x26; numerical data/trends : Length of Stay/statistics &#x26; numerical data/trends : Salaries and Fringe Benefits/statistics &#x26; numerical data/trends : United States</p><p>issue_number: 3</p><p>ntis_number: PB95-123477</p><p>page_range: 157-187</p><p>primary_author: Donham, Carolyn S</p><p>title: Health care indicators</p><p>volume: 15</p><p>year_period: 1994 Spring</p>]]></description></item><item><title>State Medicaid pharmacy payments and their relation to estimated costs.</title><pubDate>Mon, 04 Nov 2019 02:27:08 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191310</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191310</guid><description><![CDATA[<p>abstract: Although prescription drugs do not appear to be a primary source of recent surges in Medicaid spending, their share of Medicaid expenditures has risen despite efforts to control costs. As part of a general concern with prescription drug policy, Congress mandated a study of the adequacy of Medicaid payments to pharmacies. In this study, several data sources were used to develop 1991 estimates of average pharmacy ingredient and dispensing costs. A simulation was used to estimate the amounts States pay. Nationally, simulated payments averaged 96 percent of estimated costs overall but were lower for dispensing costs (79 percent) and higher for ingredient costs (102 percent).</p><p>authors: Gondek, Kathleen E; Kreling, David H</p><p>issue_mesh: Data Collection : Drug Costs/statistics &#x26; numerical data : Drugs, Generic/economics : Health Care Costs/statistics &#x26; numerical data : Insurance, Pharmaceutical Services/economics/statistics &#x26; numerical data : Medicaid/economics/statistics &#x26; numerical data : Models, Economic : Prescriptions, Drug/economics : Rate Setting and Review : State Health Plans/economics : United States</p><p>issue_number: 3</p><p>ntis_number: PB95-123477</p><p>page_range: 25-42</p><p>primary_author: Adams, E Kathleen</p><p>title: State Medicaid pharmacy payments and their relation to estimated costs.</p><p>volume: 15</p><p>year_period: 1994 Spring</p>]]></description></item><item><title>Estimating the cost of a Medicare outpatient prescription drug benefit.</title><pubDate>Mon, 04 Nov 2019 02:27:08 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191314</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191314</guid><description><![CDATA[<p>abstract: People enrolled in Medicare account for more than one-third of all outpatient prescription drug expenditures in the United States. That being the case, a proposed prescription drug benefit under the Medicare program would insure a substantial part of the market and would create the largest expansion of the program in the past 20 years. This article explains how the cost of a drug benefit was estimated as part of the Clinton Administration's health reform initiative.</p><p>authors: N/A</p><p>issue_mesh: Aged : Aged, 80 and over : Ambulatory Care/economics : Disabled Persons/statistics &#x26; numerical data : Drug Costs/statistics &#x26; numerical data : Health Care Costs/statistics &#x26; numerical data : Health Care Reform : Human : Insurance, Pharmaceutical Services/economics/statistics &#x26; numerical data : Medicare/economics/statistics &#x26; numerical data : Models, Economic : Outpatients/statistics &#x26; numerical data : Prescriptions, Drug/economics : United States</p><p>issue_number: 3</p><p>ntis_number: PB95-123477</p><p>page_range: 103-112</p><p>primary_author: Waldo, Daniel R</p><p>title: Estimating the cost of a Medicare outpatient prescription drug benefit.</p><p>volume: 15</p><p>year_period: 1994 Spring</p>]]></description></item><item><title>Payment, administration, and financing of the Medicaid program.</title><pubDate>Mon, 04 Nov 2019 02:27:08 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191234</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191234</guid><description><![CDATA[<p>ntis_number: PB99-106460</p><p>page_range: 285-301</p><p>primary_author: Gurny, Paul</p><p>title: Payment, administration, and financing of the Medicaid program.</p><p>volume: Supp.</p><p>year_period: 1992 Supp.</p>]]></description></item><item><title>Explaining resource consumption among non-normal neonates.</title><pubDate>Mon, 04 Nov 2019 02:27:07 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191195</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191195</guid><description><![CDATA[<p>abstract: The adoption by Medicare in 1983 of prospective payment using diagnosis-related groups (DRGs) has stimulated research to develop case-mix grouping schemes that more accurately predict resource consumption by patients. In this article, the authors explore a new method designed to improve case-mix classification for newborns through the use of birth weight in combination with DRGs to adjust the unexplained case-mix severity. Although the findings are developmental in nature, they reveal that the model significantly improves our ability to explain resource use.</p><p>authors: Michelman, Thomas; Pezzullo, John; Phibbs, Ciaran S</p><p>issue_mesh: Birth Weight : Diagnosis-Related Groups/classification/economics : Health Care Costs/statistics &#x26; numerical data : Health Resources/utilization : Health Services Research/methods : Hospitals, Urban/economics/utilization : Human : Infant, Newborn : Infant, Newborn, Diseases/classification/economics : Intensive Care Units, Neonatal/economics/utilization : Length of Stay/statistics &#x26; numerical data : Models, Statistical : Prospective Payment System : Regression Analysis : Severity of Illness Index : United States</p><p>issue_number: 2</p><p>ntis_number: PB92-167279</p><p>page_range: 19-28</p><p>primary_author: Schwartz, Rachel M</p><p>title: Explaining resource consumption among non-normal neonates.</p><p>volume: 13</p><p>year_period: 1991 Winter</p>]]></description></item><item><title>Medicare's prospective payment system: a critical appraisal.</title><pubDate>Mon, 04 Nov 2019 02:27:07 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191180</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191180</guid><description><![CDATA[<p>ntis_number: PB99-106478</p><p>page_range: 45-77</p><p>primary_author: Coulam, Robert F</p><p>title: Medicare's prospective payment system: a critical appraisal.</p><p>volume: Supp.</p><p>year_period: 1991 Supp.</p>]]></description></item><item><title>Health insurance coverage among disabled Medicare enrollees.</title><pubDate>Mon, 04 Nov 2019 02:27:07 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191166</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191166</guid><description><![CDATA[<p>abstract: In this article, we use the Survey of Income and Program Participation to identify patterns of non-Medicare insurance coverage among disabled Medicare enrollees. Compared with the aged, the disabled are less likely to have private insurance coverage and more likely to have Medicaid. Probit analysis of the determinants of private insurance for disabled Medicare enrollees shows that income, education, marital status, sex, and having an employed family member are positively related to the likelihood of having private health insurance, whereas age and the probability of Medicaid enrollment are negatively related to this likelihood.</p><p>authors: Wilcox-Gok, Virginia</p><p>issue_mesh: Aged : Comparative Study : Disabled Persons/statistics &#x26; numerical data : Eligibility Determination : Human : Insurance, Health/statistics &#x26; numerical data : Medicaid/statistics &#x26; numerical data : Medicare/statistics &#x26; numerical data : Models, Statistical : Socioeconomic Factors : Support, Non-U.S. Gov't : Support, U.S. Gov't, P.H.S. : United States</p><p>issue_number: 4</p><p>ntis_number: PB2001-105731</p><p>page_range: 27-37</p><p>primary_author: Rubin, Jeffrey I</p><p>title: Health insurance coverage among disabled Medicare enrollees.</p><p>volume: 12</p><p>year_period: 1991 Summer</p>]]></description></item><item><title>An evaluation of diagnosis-related group severity and complexity refinement.</title><pubDate>Mon, 04 Nov 2019 02:27:07 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191168</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191168</guid><description><![CDATA[<p>abstract: In 1988, an ambitious and extensive project was undertaken in New Jersey to evaluate severity class adjustment of the all-payer prospective payment system. Another project objective was to evaluate alternative strategies for refining diagnosis-related groups (DRGs). The evaluation presented here includes a comparison of DRG refinement using Computerized Severity Index classes and Yale University complexity classes. Statistical methods and payment simulations are used to assess the impact of DRG refinement and consequent revenue changes. When a high volume subset of DRGs is refined, simulated payment shifts between hospitals on the order of 5 percent of total hospital costs are indicated by this analysis.</p><p>authors: N/A</p><p>issue_mesh: Severity of Illness Index : Comorbidity : Costs and Cost Analysis/statistics &#x26; numerical data : Diagnosis-Related Groups/classification : Economics, Hospital/statistics &#x26; numerical data : Evaluation Studies : Hospital Bed Capacity : Medicare/organization &#x26; administration : Models, Theoretical : New Jersey : Reimbursement Mechanisms : Rural Population : Suburban Population : United States : Urban Population</p><p>issue_number: 4</p><p>ntis_number: PB2001-105731</p><p>page_range: 49-60</p><p>primary_author: McGuire, Thomas E</p><p>title: An evaluation of diagnosis-related group severity and complexity refinement.</p><p>volume: 12</p><p>year_period: 1991 Summer</p>]]></description></item><item><title>Financial aspects of adult day care: national survey results.</title><pubDate>Mon, 04 Nov 2019 02:27:07 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191156</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191156</guid><description><![CDATA[<p>abstract: Using data from a national survey of adult day care centers, it was found that a typical center had revenues of approximately $140,000 and expenses that were slightly higher. Most of the revenue was from Federal sources, with Medicaid being the largest single source. The median cost per participant day was $29.50, over one-half of which was attributable to labor expenses. To the extent that adult day care programs can better utilize their capacity, considerable savings could be made in cost per participant day.</p><p>authors: Elston, Jennifer M; Weissert, William G</p><p>issue_mesh: Adult : Costs and Cost Analysis/statistics &#x26; numerical data : Data Collection : Day Care/economics/organization &#x26; administration : Financing, Government/statistics &#x26; numerical data : Financing, Organized/statistics &#x26; numerical data : Food Services/economics : Human : Income/statistics &#x26; numerical data : Models, Theoretical : Organizational Affiliation/statistics &#x26; numerical data : Personnel Staffing and Scheduling/economics : Sampling Studies : Support, Non-U.S. Gov't : Transportation of Patients/economics</p><p>issue_number: 3</p><p>ntis_number: PB91-201384</p><p>page_range: 27-36</p><p>primary_author: Zelman, William M</p><p>title: Financial aspects of adult day care: national survey results.</p><p>volume: 12</p><p>year_period: 1991 Spring</p>]]></description></item><item><title>A comprehensive payment model for short- and long-stay psychiatric patients.</title><pubDate>Mon, 04 Nov 2019 02:27:07 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191298</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191298</guid><description><![CDATA[<p>abstract: In this article, a payment model is developed for a hospital system with both acute- and chronic-stay psychiatric patients. "Transition pricing" provides a balance between the incentives of an episode-based system and the necessity of per diem long-term payments. Payment is dependent on two new psychiatric resident classification systems for short- and long-term stays. Data on per diem cost of inpatient care, by day of stay, was computed from a sample of 2,968 patients from 100 psychiatric units in 51 Department of Veterans Affairs (VA) Medical Centers. Using a 9-month cohort of all VA psychiatric discharges nationwide (79,337 with non-chronic stays), profits and losses were simulated.</p><p>authors: Ashcraft, Marie L; Durance, Paul W; Nerenz, David R</p><p>issue_mesh: Acute Disease/classification/economics : Diagnosis-Related Groups/classification/economics : Episode of Care : Health Services Research : Hospital Costs/statistics &#x26; numerical data : Hospitals, Veterans/economics : Human : Insurance, Health, Reimbursement/statistics &#x26; numerical data : Length of Stay/economics/statistics &#x26; numerical data : Long-Term Care/classification/economics : Mental Disorders/classification/economics : Models, Statistical : Psychiatric Department, Hospital/economics : Rate Setting and Review/methods : Support, Non-U.S. Gov't : Support, U.S. Gov't, Non-P.H.S. : United States : United States Department of Veterans Affairs</p><p>issue_number: 2</p><p>ntis_number: PB95-123469</p><p>page_range: 31-50</p><p>primary_author: Fries, Brant E</p><p>title: A comprehensive payment model for short- and long-stay psychiatric patients.</p><p>volume: 15</p><p>year_period: 1993 Winter</p>]]></description></item><item><title>A profile of the Medicare Current Beneficiary Survey.</title><pubDate>Mon, 04 Nov 2019 02:27:07 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191330</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191330</guid><description><![CDATA[<p>abstract: This article presents the logic, methods, and capabilities of a major new source of data on the Medicare population, the Medicare Current Beneficiary Survey (MCBS). The survey originated from the need to provide valid estimates of various kinds of health care spending, such as long-term care spending or expenditures by different age groups, to describe the effects of the Medicare program on its beneficiaries, and to model the effects of proposed program changes. Presented here is an account of the MCBS sampling and data collection design and the analytic strengths of the resulting data. Of special interest are the use of Computer-Assisted Personal Interviewing (CAPI); sampling from Medicare enrollment files; design for both cross-sectional and longitudinal analysis; surveying both community and facility residents; and merging survey and administrative data.</p><p>authors: N/A</p><p>issue_mesh: Adolescence : Adult : Aged : Child : Data Interpretation, Statistical : Health Services Research/methods : Human : Interviews : Medicare/statistics &#x26; numerical data/utilization : Middle Age : Research Design : United States Health Care Financing Administration</p><p>issue_number: 4</p><p>ntis_number: PB99-106437</p><p>page_range: 153-163</p><p>primary_author: Adler, Gerald S</p><p>title: A profile of the Medicare Current Beneficiary Survey.</p><p>volume: 15</p><p>year_period: 1994 Summer</p>]]></description></item><item><title>Findings from the Medicaid Competition Demonstrations: a guide for states.</title><pubDate>Mon, 04 Nov 2019 02:27:07 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191103</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191103</guid><description><![CDATA[<p>abstract: The Medicaid Competition Demonstrations were initiated in 1983-84 in six States (California, Florida, Minnesota, Missouri, New Jersey, and New York). State experiences in implementing the demonstrations are presented in this article. Although problems of enrolling Medicaid recipients in prepaid plans or with primary care case managers under these demonstrations proved challenging to States, lessons were learned in three key areas: program design and administration, health plan and provider relations, and beneficiary acceptance. Therefore, States considering similar programs in the future could benefit from these findings.</p><p>authors: Anderson, Maren D; Fox, Peter D</p><p>issue_mesh: Program Evaluation : Cost Control/methods : Economic Competition : Managed Care Programs/organization &#x26; administration : Medicaid/organization &#x26; administration : Pilot Projects : State Government : United States</p><p>issue_number: 4</p><p>ntis_number: PB91-105973</p><p>page_range: 55-67</p><p>primary_author: Heinen, LuAnn</p><p>title: Findings from the Medicaid Competition Demonstrations: a guide for states.</p><p>volume: 11</p><p>year_period: 1990 Summer</p>]]></description></item><item><title>Medicaid payment policies for nursing home care: a national survey.</title><pubDate>Mon, 04 Nov 2019 02:27:07 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191186</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191186</guid><description><![CDATA[<p>abstract: This research gives a comprehensive overview of the nursing home payment methodologies used by each State Medicaid program. To present this comprehensive overview, 1988 data were collected by survey from 49 States and the District of Columbia. The literature was reviewed and integrated into the study to provide a theoretical framework to analyze the collected data. The data are organized and presented as follows: payment levels, payment methods, payment of capital-related costs, and incentives in nursing home payment. We conclude with a discussion of the impact these different methodologies have on program cost containment, quality, and recipient access.</p><p>authors: Madel, R Peter; Persons, Dan</p><p>issue_mesh: Reimbursement Mechanisms : Capital Expenditures : Data Collection : Intermediate Care Facilities/economics : Medicaid/organization &#x26; administration/statistics &#x26; numerical data : Nursing Homes/economics : Questionnaires : Rate Setting and Review/statistics &#x26; numerical data : Reimbursement, Incentive : Skilled Nursing Facilities/economics : State Health Plans/economics : United States</p><p>issue_number: 1</p><p>ntis_number: PB92-128255</p><p>page_range: 55-72</p><p>primary_author: Buchanan, Robert J</p><p>title: Medicaid payment policies for nursing home care: a national survey.</p><p>volume: 13</p><p>year_period: 1991 Fall</p>]]></description></item><item><title>The Medicare home health initiative.</title><pubDate>Mon, 04 Nov 2019 02:27:07 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191334</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191334</guid><description><![CDATA[<p>abstract: This article describes the Medicare home health benefit and summarizes growth and change in the use of the benefit and in the industry providing home health care. The article also details the organization and goals of the Home Health Initiative, describes its four key components quality assurance (QA), administration, policy, and research-and concludes with a discussion of the status of the Initiative.</p><p>authors: Miller, Nancy A</p><p>issue_mesh: Health Care Reform : Health Services Research : Home Care Services/economics/organization &#x26; administration : Insurance Benefits : Medicare/organization &#x26; administration/utilization : Organizational Innovation : Organizational Policy : Policy Making : United States : United States Health Care Financing Administration</p><p>issue_number: 1</p><p>ntis_number: PB2001-105546</p><p>page_range: 7-16</p><p>primary_author: Vladeck, Bruce C</p><p>title: The Medicare home health initiative.</p><p>volume: 16</p><p>year_period: 1994 Fall</p>]]></description></item><item><title>Projections of national health expenditures through the year 2000.</title><pubDate>Mon, 04 Nov 2019 02:27:07 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191184</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191184</guid><description><![CDATA[<p>abstract: In this article, the authors present a scenario for health expenditures during the 1990s. Assuming that current laws and practices remain unchanged, the Nation will spend $1.6 trillion for health care in the year 2000, an amount equal to 16.4 percent of that year's gross national product. Medicare and Medicaid will foot an increasing share of the Nation's health bill, rising to more than one-third of the total. The factors accounting for growth in national health spending are described as well as the effects of those factors on spending by type of service and by source of funds.</p><p>authors: Lemieux, Jeffrey A; McKusick, David R; Waldo, Daniel R</p><p>issue_mesh: Forecasting : Models, Econometric : Actuarial Analysis : Data Collection : Drug Costs/trends : Health Expenditures/statistics &#x26; numerical data/trends : Health Manpower/trends : Hospitals, Community/economics : Medicaid/statistics &#x26; numerical data : Medicare/statistics &#x26; numerical data : Nursing Homes/economics : Personal Health Services/economics : United States</p><p>issue_number: 1</p><p>ntis_number: PB92-128255</p><p>page_range: 1-28</p><p>primary_author: Sonnefeld, Sally T</p><p>title: Projections of national health expenditures through the year 2000.</p><p>volume: 13</p><p>year_period: 1991 Fall</p>]]></description></item><item><title>Trends in Medicare health maintenance organization enrollment: 1986-93.</title><pubDate>Mon, 04 Nov 2019 02:27:07 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191294</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191294</guid><description><![CDATA[<p>abstract: This study examines Medicare health maintenance organization (HMO) enrollment under the Tax Equity and Fiscal Responsibility Act (TEFRA) of 1982 (Public Law 97-248) from 1986 to 1993. It shows that there was moderate growth in the number of Medicare beneficiaries participating in the TEFRA risk program, reaching 1 in 20 beneficiaries in 1993. Medicare HMO enrollment is heavily concentrated in a few large plans, resulting in heavy concentrations geographically. California and Florida accounted for over one-third of Medicare HMO enrollees. One-half of the States have no Medicare HMO enrollment and one-fifth of the States have fewer than 15,000 Medicare HMO enrollees.</p><p>authors: N/A</p><p>issue_mesh: Capitation Fee : Data Collection : Health Maintenance Organizations/classification/statistics &#x26; numerical data/trends/utilization : Health Services Research : Longitudinal Studies : Medicare/organization &#x26; administration/statistics &#x26; numerical data/utilization : Ownership : Risk : United States : United States Health Care Financing Administration</p><p>issue_number: 1</p><p>ntis_number: PB95-123493</p><p>page_range: 135-146</p><p>primary_author: McMillan, Alma</p><p>title: Trends in Medicare health maintenance organization enrollment: 1986-93.</p><p>volume: 15</p><p>year_period: 1993 Fall</p>]]></description></item><item><title>New Jersey's Medicaid waiver for acquired immunodeficiency syndrome.</title><pubDate>Mon, 04 Nov 2019 02:27:07 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191205</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191205</guid><description><![CDATA[<p>abstract: This article contains data from a study of New Jersey's home and community-based Medicaid waiver program for persons with symptomatic human immunodeficiency virus illness. Major findings include lower hospital costs and utilization for waiver participants compared with general Medicaid acquired immunodeficiency syndrome admissions in New Jersey. Average program expenditures were $2,400 per person per month. Based on study findings, it is evident that the waiver program is an important means of providing financial benefits and access to services and that comprehensive case management is a critical factor in assuring program quality.</p><p>authors: Crystal, Stephen; Karus, Daniel; Kurland, Carol; Sambamoorthi, Usha</p><p>issue_mesh: Acquired Immunodeficiency Syndrome/economics/therapy : Adolescence : Adult : Child : Data Collection : Female : Health Expenditures/statistics &#x26; numerical data : Health Services Accessibility/statistics &#x26; numerical data : Health Services Research : Home Care Services/economics/utilization : Hospitalization/statistics &#x26; numerical data : Human : Male : Medicaid/legislation &#x26; jurisprudence/statistics &#x26; numerical data/utilization : New Jersey : Patient Care Planning/statistics &#x26; numerical data : Program Evaluation : State Health Plans/legislation &#x26; jurisprudence : Support, U.S. Gov't, P.H.S. : United States</p><p>issue_number: 3</p><p>ntis_number: PB2001-105738</p><p>page_range: 27-44</p><p>primary_author: Merzel, Cheryl</p><p>title: New Jersey's Medicaid waiver for acquired immunodeficiency syndrome.</p><p>volume: 13</p><p>year_period: 1992 Spring</p>]]></description></item><item><title>Setting capitations for Medicaid: a case study.</title><pubDate>Mon, 04 Nov 2019 02:27:07 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191105</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191105</guid><description><![CDATA[<p>abstract: This article examines the methodology New York State used to set capitation rates for a Medicaid health maintenance organization. By examining the methods used and the assumptions made in a particular case, some general lessons are drawn about the ratesetting process. Greater reliance on statewide data to assure fair and statistically stable estimates is needed. Although the article focuses on one State and its ratesetting for one particular plan (Health Care Plus), the issues raised have general interest for other plans and for other States concerned with the setting of capitation rates for Medicaid enrollees in prepaid plans.</p><p>authors: Buchanan, Joan L</p><p>issue_mesh: Capitation Fee : Health Maintenance Organizations/economics : Medicaid/organization &#x26; administration : New York : Rate Setting and Review/methods : Support, U.S. Gov't, Non-P.H.S. : United States</p><p>issue_number: 4</p><p>ntis_number: PB91-105973</p><p>page_range: 79-85</p><p>primary_author: Leibowitz, Arlene</p><p>title: Setting capitations for Medicaid: a case study.</p><p>volume: 11</p><p>year_period: 1990 Summer</p>]]></description></item><item><title>Longitudinal patterns of California Medicaid recipients with acquired immunodeficiency syndrome.</title><pubDate>Mon, 04 Nov 2019 02:27:07 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191193</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191193</guid><description><![CDATA[<p>abstract: In this study, the authors examine the longitudinal experience, annual trends, and subpopulation differences in Medicaid use and expenditures for persons with acquired immunodeficiency syndrome (AIDS) in California from 1983 through 1986. About two-thirds of adult males were enrolled in Medicaid within 1 month of their AIDS diagnosis. These recipients averaged approximately 20-percent higher lifetime expenditures than those enrolled at a later time. Monthly expenditures were higher in the beginning of enrollment and prior to death than in the months in between. From 1983 through 1986, there was a shift of care from inpatient to outpatient settings. In 1986, children and adult females had higher median expenditures than did adult males.</p><p>authors: Keyes, Margaret A; Pine, Penelope L</p><p>issue_mesh: Acquired Immunodeficiency Syndrome/economics : Adult : Ambulatory Care/economics/utilization : California : Child : Female : Health Expenditures/statistics &#x26; numerical data : Hospitalization/economics/statistics &#x26; numerical data : Human : Longitudinal Studies : Male : Medicaid/statistics &#x26; numerical data/utilization : Support, U.S. Gov't, Non-P.H.S. : United States</p><p>issue_number: 2</p><p>ntis_number: PB92-167279</p><p>page_range: 1-12</p><p>primary_author: Andrews, Roxanne M</p><p>title: Longitudinal patterns of California Medicaid recipients with acquired immunodeficiency syndrome.</p><p>volume: 13</p><p>year_period: 1991 Winter</p>]]></description></item><item><title>Activities of daily living and costs in nursing homes.</title><pubDate>Mon, 04 Nov 2019 02:27:07 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191328</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191328</guid><description><![CDATA[<p>abstract: Functionality, as measured by activities of daily living (ADL), is the most important predictor of the cost of nursing home care. Data from a field-test version of the federally mandated Minimum Data Set (MDS) were examined using analysis of variance (ANOVA) and recursive partitioning methods to determine the relationships between ADL limitations and nursing cost (wage-weighted nursing time) among nursing home residents (n = 6,663). From this analysis, an index based on limitations in four ADLs was created. The developed ADL index is a readily determined measure of functional status useful in allocating nursing staff within nursing homes and in comparing the functional status of groups of residents, explaining 30 percent of variance in nursing costs among nursing home residents.</p><p>authors: Foley, William J; Fries, Brant E; Gavazzi, Marie; Schneider, Don P</p><p>issue_mesh: Activities of Daily Living : Aged : Analysis of Variance : Data Collection : Diagnosis-Related Groups/statistics &#x26; numerical data : Health Care Costs/statistics &#x26; numerical data : Health Services Research : Human : Long-Term Care/classification : Nursing Homes/economics/statistics &#x26; numerical data : Nursing Services/utilization : Time and Motion Studies : United States</p><p>issue_number: 4</p><p>ntis_number: PB99-106437</p><p>page_range: 117-135</p><p>primary_author: Williams, Brent C</p><p>title: Activities of daily living and costs in nursing homes.</p><p>volume: 15</p><p>year_period: 1994 Summer</p>]]></description></item><item><title>Swan-Ganz catheter use and mortality of myocardial infarction patients.</title><pubDate>Mon, 04 Nov 2019 02:27:07 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191326</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191326</guid><description><![CDATA[<p>abstract: Using the 1989 Medicare provider analysis and review (MEDPAR) file, we calculated a 30-day indirectly standardized mortality ratio (SMR) for all "fresh" acute myocardial infarction (AMI) Medicare aged cases (i.e., fresh AMI patients are those who had not reported an AMI in the prior 8 weeks) at 2,900 hospitals, as well as an indirectly standardized procedure ratio (SPR) of Swan-Ganz catheter (SGC) use for these AMI cases at each hospital. Cases at hospitals with higher SGC SPRs also had higher SMRs. This positive association persisted when hospitals were further stratified by their annual volume of fresh AMI cases. We believe that our use of cases as the unit of observation, stratified by the SGC SPR of their hospital, avoids some case selection bias in observational studies directly comparing risk-adjusted mortality of cases with and without SGC.</p><p>authors: Binns, Gregory S</p><p>issue_mesh: Hospital Mortality : Aged : Catheterization, Swan-Ganz/statistics &#x26; numerical data/utilization : Data Collection : Evaluation Studies : Human : Least-Squares Analysis : Logistic Models : Medicare/utilization : Myocardial Infarction/mortality/surgery : Treatment Outcome : United States/epidemiology</p><p>issue_number: 4</p><p>ntis_number: PB99-106437</p><p>page_range: 91-103</p><p>primary_author: Blumberg, Mark S</p><p>title: Swan-Ganz catheter use and mortality of myocardial infarction patients.</p><p>volume: 15</p><p>year_period: 1994 Summer</p>]]></description></item><item><title>International infant mortality rankings: a look behind the numbers.</title><pubDate>Mon, 04 Nov 2019 02:27:07 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191215</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191215</guid><description><![CDATA[<p>abstract: The very unfavorable infant mortality ranking of the United States in international comparisons is often used to question the quality of health care there. Infant mortality rates, however, implicitly capture a complicated story, measuring much more than differences in health care across countries. This article examines reasons behind international infant mortality rate rankings, including variations in the measurement of vital events, and differences in risk factors across countries. Its goal is to offer a broader context for more informed debate on the meaning of international infant mortality statistics. These statistics offer opportunities to identify strategies for improving the U.S. health care system and learn from other countries that have been more successful.</p><p>authors: Chawla, Juhi; Moon, Marilyn; Sulvetta, Margaret B</p><p>issue_mesh: Infant Mortality : Adolescence : Adult : Canada : Comparative Study : Cross-Cultural Comparison : Data Collection/standards : Europe : Female : Health Services Accessibility/statistics &#x26; numerical data : Human : Infant : Infant, Low Birth Weight : Infant, Newborn : Japan : Maternal Age : Pregnancy : Quality of Health Care/statistics &#x26; numerical data : Risk Factors : Socioeconomic Factors : Support, U.S. Gov't, Non-P.H.S. : United States</p><p>issue_number: 4</p><p>ntis_number: PB2001-105740</p><p>page_range: 105-118</p><p>primary_author: Liu, Korbin</p><p>title: International infant mortality rankings: a look behind the numbers.</p><p>volume: 13</p><p>year_period: 1992 Summer</p>]]></description></item><item><title>Health care indicators.</title><pubDate>Mon, 04 Nov 2019 02:27:07 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191202</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191202</guid><description><![CDATA[<p>authors: Cowan, Cathy A; Donham, Carolyn S; Letsch, Suzanne W</p><p>issue_mesh: Data Collection : Employment/statistics &#x26; numerical data : Health Care Costs/statistics &#x26; numerical data : Health Manpower/statistics &#x26; numerical data : Hospitals, Community/statistics &#x26; numerical data : United States</p><p>issue_number: 2</p><p>ntis_number: PB92-167279</p><p>page_range: 95-114</p><p>primary_author: Maple, Brenda T</p><p>title: Health care indicators.</p><p>volume: 13</p><p>year_period: 1991 Winter</p>]]></description></item><item><title>Trends in total hospital financial performance under the prospective payment system.</title><pubDate>Mon, 04 Nov 2019 02:27:07 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191203</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191203</guid><description><![CDATA[<p>abstract: In this article, the author examines trends in determinants of total hospital facility revenues, expenses, and net profits during the period 1977-89. Measures of change in transaction prices are developed, which enable an analysis of trends in real hospital outputs and total factor productivity. The main source of hospital spending growth in excess of the gross national product is identified as growth in hospital employee compensation.</p><p>authors: N/A</p><p>issue_mesh: Capital Expenditures/statistics &#x26; numerical data : Data Collection : Economics, Hospital/statistics &#x26; numerical data/trends : Financial Management, Hospital/trends : Hospitalization/statistics &#x26; numerical data : Income/statistics &#x26; numerical data : Medicare/economics : Personnel Staffing and Scheduling/economics/statistics &#x26; numerical data : Prospective Payment System/statistics &#x26; numerical data : Salaries and Fringe Benefits/statistics &#x26; numerical data/trends : United States</p><p>issue_number: 3</p><p>ntis_number: PB2001-105738</p><p>page_range: 1-16</p><p>primary_author: Fisher, Charles R</p><p>title: Trends in total hospital financial performance under the prospective payment system.</p><p>volume: 13</p><p>year_period: 1992 Spring</p>]]></description></item><item><title>Managed care: practice, pitfalls, and potential.</title><pubDate>Mon, 04 Nov 2019 02:27:06 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191178</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191178</guid><description><![CDATA[<p>ntis_number: PB99-106478</p><p>page_range: 27-34</p><p>primary_author: Wallack, Stanley S</p><p>title: Managed care: practice, pitfalls, and potential.</p><p>volume: Supp.</p><p>year_period: 1991 Supp.</p>]]></description></item><item><title>Health care indicators.</title><pubDate>Mon, 04 Nov 2019 02:27:06 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191174</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191174</guid><description><![CDATA[<p>abstract: Contained in this regular feature of the journal is a section on each of the following four topics: community hospital statistics; employment, hours, and earnings in the private health sector; prices; and national economic indicators. These statistics are valuable in their own right for understanding the relationship between the health care sector and the overall economy. In addition, they provide indicators of the direction and magnitude of health care costs prior to the availability of more comprehensive data.</p><p>authors: Cowan, Cathy A; Letsch, Suzanne W; Maple, Brenda T; Singer, Naphtale</p><p>issue_mesh: Abstracting and Indexing : Bed Occupancy/statistics &#x26; numerical data : Data Collection : Employment/statistics &#x26; numerical data : Fees and Charges/statistics &#x26; numerical data : Home Care Services/economics : Hospitals, Community/statistics &#x26; numerical data : Income/statistics &#x26; numerical data : Inflation, Economic/statistics &#x26; numerical data : Salaries and Fringe Benefits/statistics &#x26; numerical data : Skilled Nursing Facilities/economics</p><p>issue_number: 4</p><p>ntis_number: PB2001-105731</p><p>page_range: 141-170</p><p>primary_author: Donham, Carolyn S</p><p>title: Health care indicators.</p><p>volume: 12</p><p>year_period: 1991 Summer</p>]]></description></item><item><title>Physician cost experience under private health insurance programs.</title><pubDate>Mon, 04 Nov 2019 02:27:06 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191210</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191210</guid><description><![CDATA[<p>abstract: Little information is available on private payer claims cost experience for specific categories of health care. A study was conducted in which physician-claims cost experience and trends among 15 Blue Cross and Blue Shield Plans were compared. Between 1986 and 1988, physician claims cost per covered person increased at an average annual rate of 17 percent, approximately 6 percentage points higher than for Medicare. Annual charges were highest for laboratory (24 percent), radiology (19 percent), and medical care (18 percent) services. Utilization trends were also examined in the study. The number of radiology imaging procedures performed increased 48 percent between 1986 and 1988, and the number of hospital visits declined by 6 percent.</p><p>authors: N/A</p><p>issue_mesh: Blue Cross/economics/statistics &#x26; numerical data/utilization : Blue Shield/economics/statistics &#x26; numerical data/utilization : Data Collection : Fees, Medical/statistics &#x26; numerical data : Health Services Research : Insurance Claim Reporting : Medicare/economics/statistics &#x26; numerical data/utilization : Reimbursement Mechanisms/economics/statistics &#x26; numerical data : United States</p><p>issue_number: 3</p><p>ntis_number: PB2001-105738</p><p>page_range: 85-96</p><p>primary_author: Dyckman, Zackary</p><p>title: Physician cost experience under private health insurance programs.</p><p>volume: 13</p><p>year_period: 1992 Spring</p>]]></description></item><item><title>Output and inflation components of medical care and other spending changes.</title><pubDate>Mon, 04 Nov 2019 02:27:06 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191200</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191200</guid><description><![CDATA[<p>abstract: From 1965 to 1990, spending on medical care rose from 5.9 to 12.2 percent of gross national product. This rise was the consequence of greatly expanded government and government subsidized private insurance coverage operating in an environment where payments for insured care by and large covered whatever costs were incurred. As a result, the personal consumption of medical care experienced both output and price average growth rates strikingly above economywide norms. Indeed, the output growth rate in this sector rivaled growth in several goods sectors with greatly expanded supplies. However, whereas goods in the latter sectors have become more accessible through lower relative prices, consumers with insufficient insurance coverage are being crowded out of the market for medical care by higher relative prices.</p><p>authors: Lee, Mei L</p><p>issue_mesh: Health Expenditures/statistics &#x26; numerical data/trends : Inflation, Economic/statistics &#x26; numerical data : Insurance, Health/economics : Models, Econometric : United States</p><p>issue_number: 2</p><p>ntis_number: PB92-167279</p><p>page_range: 75-81</p><p>primary_author: Peden, Edgar A</p><p>title: Output and inflation components of medical care and other spending changes.</p><p>volume: 13</p><p>year_period: 1991 Winter</p>]]></description></item><item><title>Recent revisions to and recommendations for national health expenditures accounting.</title><pubDate>Mon, 04 Nov 2019 02:27:06 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191190</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191190</guid><description><![CDATA[<p>abstract: The Health Care Financing Administration (HCFA) has importantly revised the methodology for estimating annual national health expenditures. Among other changes, the revisions estimated out-of-pocket spending directly, disaggregated expenditures to a greater degree, and reduced undercounting and double counting. Estimates of total spending and out-of-pocket spending changed. This article summarizes a meeting of a technical advisory panel, convened by HCFA, that reviewed the modifications adopted and made recommendations for future revisions.</p><p>authors: Newhouse, Joseph P</p><p>issue_mesh: Accounting/methods : Capital Expenditures : Data Collection/standards : Financing, Personal : Health Expenditures/statistics &#x26; numerical data : Income : United States : United States Health Care Financing Administration</p><p>issue_number: 1</p><p>ntis_number: PB92-128255</p><p>page_range: 111-116</p><p>primary_author: Haber, Susan</p><p>title: Recent revisions to and recommendations for national health expenditures accounting.</p><p>volume: 13</p><p>year_period: 1991 Fall</p>]]></description></item><item><title>Health care indicators.</title><pubDate>Mon, 04 Nov 2019 02:27:06 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191212</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191212</guid><description><![CDATA[<p>authors: Donham, Carolyn S; Lazenby, Helen C; Letsch, Suzanne W; Maple, Brenda T</p><p>issue_mesh: Data Collection : Employment/statistics &#x26; numerical data : Fees and Charges/statistics &#x26; numerical data : Health Care Costs/statistics &#x26; numerical data : Hospitals, Community/statistics &#x26; numerical data : Inflation, Economic/statistics &#x26; numerical data : Prospective Payment System/statistics &#x26; numerical data : United States</p><p>issue_number: 3</p><p>ntis_number: PB2001-105738</p><p>page_range: 111-130</p><p>primary_author: Cowan, Cathy A</p><p>title: Health care indicators.</p><p>volume: 13</p><p>year_period: 1992 Spring</p>]]></description></item><item><title>Medicare physician and hospital utilization and expenditure trends.</title><pubDate>Mon, 04 Nov 2019 02:27:06 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191088</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191088</guid><description><![CDATA[<p>abstract: During the period 1983-86, the period directly following implementation of the Medicare prospective payment system, inpatient hospital care declined. Concurrently, fee-for-service utilization rates for physicians and other noninstitutional suppliers of medical goods and services and for outpatient facility care rose. Medicare expenditures for physicians and other suppliers and for outpatient facility care paralleled changes in utilization. In 1987, the proportion of Medicare patients receiving inpatient hospital care stabilized, but the proportion receiving outpatient hospital care continued to increase.</p><p>authors: Fisher, Charles R</p><p>issue_mesh: Ambulatory Care/utilization : Health Expenditures/statistics &#x26; numerical data : Hospitals/utilization : Medicare/statistics &#x26; numerical data : Prospective Payment System : United States</p><p>issue_number: 2</p><p>ntis_number: PB90-204629</p><p>page_range: 111-116</p><p>primary_author: Edwards, Winston O</p><p>title: Medicare physician and hospital utilization and expenditure trends.</p><p>volume: 11</p><p>year_period: 1989 Winter</p>]]></description></item><item><title>Health care indicators.</title><pubDate>Mon, 04 Nov 2019 02:27:06 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191192</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191192</guid><description><![CDATA[<p>authors: Cowan, Cathy A; Donham, Carolyn S; Maple, Brenda T</p><p>issue_mesh: Economics/statistics &#x26; numerical data : Employment/statistics &#x26; numerical data : Fees and Charges/statistics &#x26; numerical data : Health Manpower/statistics &#x26; numerical data : Health Services/economics : Hospitals, Community/statistics &#x26; numerical data : Inflation, Economic/statistics &#x26; numerical data : Salaries and Fringe Benefits/statistics &#x26; numerical data : United States</p><p>issue_number: 1</p><p>ntis_number: PB92-128255</p><p>page_range: 129-153</p><p>primary_author: Letsch, Suzanne W</p><p>title: Health care indicators.</p><p>volume: 13</p><p>year_period: 1991 Fall</p>]]></description></item><item><title>Concordance between planned and approved visits during initial home care.</title><pubDate>Mon, 04 Nov 2019 02:27:06 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191188</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191188</guid><description><![CDATA[<p>abstract: Based on little prior information and a brief interview, the Medicare home health agency intake case manager must estimate the types and amounts of services a new client will require during the first 60 days of home care. We systematically examined the concordance between types and amounts of planned services with those actually approved and reimbursed during the first 60 days of care for a sample of 2,431 clients during 1986. Overall, the mean number of planned visits during the first 60 days was 24.76, and the mean number of approved visits was 15.95. Approved visits as a percent of planned visits averaged 64.4.</p><p>authors: Cheh, Valerie A; Goldberg, Henry B</p><p>issue_mesh: Activities of Daily Living : Data Collection : Disease/classification : Eligibility Determination : Forms and Records Control/organization &#x26; administration : Home Care Services/utilization : House Calls/statistics &#x26; numerical data : Human : Medicare/organization &#x26; administration : Patient Care Planning/organization &#x26; administration : Program Evaluation : Reimbursement Mechanisms : Support, U.S. Gov't, Non-P.H.S. : United States</p><p>issue_number: 1</p><p>ntis_number: PB92-128255</p><p>page_range: 83-91</p><p>primary_author: Branch, Laurence G</p><p>title: Concordance between planned and approved visits during initial home care.</p><p>volume: 13</p><p>year_period: 1991 Fall</p>]]></description></item><item><title>Impact of Medicare payment policy on home health resources utilization.</title><pubDate>Mon, 04 Nov 2019 02:27:06 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191194</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191194</guid><description><![CDATA[<p>abstract: In this study, the association between Medicare regulations and the provision of public home health care is examined. Medicare clients were compared with non-Medicare groups of those 65 years of age or over and those under 65. Results suggested that both age- and payer-related factors contribute to utilization of services. Older patients showed greater need for chronic illness care relative to younger patients; however, Medicare patients used fewer resources and had poorer outcomes relative to older non-Medicare patients.</p><p>authors: Chase, Gary A; Cloonan, Patricia; Fisher, Mary E; Phillips, Elayne K; Torner, James C</p><p>issue_mesh: Adult : Age Factors : Aged : Community Health Nursing/economics/statistics &#x26; numerical data : Health Services Research : Home Care Services/economics/utilization : Human : Medicare/statistics &#x26; numerical data/utilization : Middle Age : Public Health Administration/economics : Referral and Consultation/economics/statistics &#x26; numerical data : Support, U.S. Gov't, P.H.S. : Treatment Outcome : United States : Virginia</p><p>issue_number: 2</p><p>ntis_number: PB92-167279</p><p>page_range: 13-18</p><p>primary_author: Irvine, Audrey</p><p>title: Impact of Medicare payment policy on home health resources utilization.</p><p>volume: 13</p><p>year_period: 1991 Winter</p>]]></description></item><item><title>Factors affecting the availability and use of hemodialysis facilities.</title><pubDate>Mon, 04 Nov 2019 02:27:06 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191198</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191198</guid><description><![CDATA[<p>abstract: This article describes factors related to the geographic distribution of hemodialysis facilities and the relationship between availability and use. Such facilities tend to be concentrated in the same types of areas as other medical resources, and the number of medical specialists in an area is related to the rate of treatment for renal diseases. The proportion of treatment stations in an area owned by for-profit organizations is not related to the total treatment rate, but the market share of for-profit facilities is positively related to in-center treatment and negatively related to home treatment.</p><p>authors: Blumenthal, David; Schlesinger, Mark</p><p>issue_mesh: Kidney Failure, Chronic/economics/therapy : Ambulatory Care Facilities/supply &#x26; distribution : Data Collection : Health Facilities, Proprietary/organization &#x26; administration/supply &#x26; distribution/utilization : Health Services Accessibility/statistics &#x26; numerical data : Health Services Research : Hemodialysis Units, Hospital/utilization : Hemodialysis, Home/utilization : Hemodialysis/utilization : Human : Organizational Innovation : Ownership : Professional Practice Location : Support, Non-U.S. Gov't : Support, U.S. Gov't, P.H.S. : United States</p><p>issue_number: 2</p><p>ntis_number: PB92-167279</p><p>page_range: 49-55</p><p>primary_author: Cleary, Paul D</p><p>title: Factors affecting the availability and use of hemodialysis facilities.</p><p>volume: 13</p><p>year_period: 1991 Winter</p>]]></description></item><item><title>National health accounts: lessons from the U.S. experience.</title><pubDate>Mon, 04 Nov 2019 02:27:06 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191214</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191214</guid><description><![CDATA[<p>abstract: The national health accounts (NHA) are the framework within which type of services and sources of funding for health care expenditures are measured. NHA, devised to portray the structure of health care delivery and financing in the United States, provide essential information necessary for the formulation of public health policy and for international comparison. In this article, the authors describe the importance of the NHA nationally and internationally, and provide a blueprint of the definitions, sources, and methods used to create this system of NHA in the United States.</p><p>authors: Adler, Gerald S; Cowan, Cathy A; Letsch, Suzanne W; Levit, Katharine R; Waldo, Daniel R</p><p>issue_mesh: Accounting/methods : Data Collection : Financing, Organized/classification/statistics &#x26; numerical data : Health Expenditures/statistics &#x26; numerical data : Health Resources/classification/economics : Health Services/classification/economics : Models, Econometric : United States</p><p>issue_number: 4</p><p>ntis_number: PB2001-105740</p><p>page_range: 89-103</p><p>primary_author: Lazenby, Helen C</p><p>title: National health accounts: lessons from the U.S. experience.</p><p>volume: 13</p><p>year_period: 1992 Summer</p>]]></description></item><item><title>Health of retired workers: survival status and Medicare service use.</title><pubDate>Mon, 04 Nov 2019 02:27:06 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191208</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191208</guid><description><![CDATA[<p>abstract: Data from the Social Security Administration's 1982 New Beneficiary Survey and Master Beneficiary Record were matched with 1984 data from the Medicare Automated Data Retrieval System to study the effects of self-reported health on subsequent health service usage and survival. Proportionately, more new retired workers who reported poorer health in 1982 were decreased by December 1984. Functionally dependent beneficiaries as determined by the Functional Capacity Limitation Index had death rates four to five times greater than those who reported no limitations. The health status of retired workers who received Social Security benefits before age 65 was no better than beneficiaries 65 or over. Decedents were more likely than survivors to incur Medicare charges, and to have substantially higher median charges--$8,834 compared with $285.</p><p>authors: Iams, Howard M; Packard, Michael D; Shapiro, Jeffrey</p><p>issue_mesh: Health Surveys : Treatment Outcome : Age Factors : Aged : Fees and Charges/statistics &#x26; numerical data : Female : Health Services for the Aged/economics/utilization : Health Status : Human : Longitudinal Studies : Male : Medicare/economics/utilization : Middle Age : Retirement/economics/statistics &#x26; numerical data : Sex Factors : Survival Analysis : United States</p><p>issue_number: 3</p><p>ntis_number: PB2001-105738</p><p>page_range: 65-76</p><p>primary_author: McCoy, John L</p><p>title: Health of retired workers: survival status and Medicare service use.</p><p>volume: 13</p><p>year_period: 1992 Spring</p>]]></description></item><item><title>Good quality care increases hospital profits under prospective payment.</title><pubDate>Mon, 04 Nov 2019 02:27:06 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191204</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191204</guid><description><![CDATA[<p>abstract: This study shows that, contrary to popular belief, the prospective payment system discourages skimping on medically indicated care. The quality of care on a nationally representative sample of Medicare discharges underwent judgmental review using implicit criteria. The reviewing physicians identified hospitalizations that omitted medically indicated services and diagnoses overlooked because of this skimping. After deduction for the cost of the omitted services and probability of negative diagnostic tests, good quality care would have increased hospital profits a significant 7.9 percent. As the specificity of diagnosis and intensity of treatment increase, the DRG payment rises faster than the cost of providing medically indicated services.</p><p>authors: Ahern, Cathaleen A</p><p>issue_mesh: Data Collection : Diagnosis-Related Groups/economics/statistics &#x26; numerical data : Economics, Hospital/statistics &#x26; numerical data/trends : Evaluation Studies : Health Services Research : Human : Income/statistics &#x26; numerical data : Patient Discharge/statistics &#x26; numerical data : Prospective Payment System/economics : Quality of Health Care/economics/standards : United States</p><p>issue_number: 3</p><p>ntis_number: PB2001-105738</p><p>page_range: 17-26</p><p>primary_author: Hsia, David C</p><p>title: Good quality care increases hospital profits under prospective payment.</p><p>volume: 13</p><p>year_period: 1992 Spring</p>]]></description></item><item><title>U.S. health expenditure performance: an international comparison and data update.</title><pubDate>Mon, 04 Nov 2019 02:27:06 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191213</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191213</guid><description><![CDATA[<p>abstract: In this article, the authors present the most recently available data on the health care financing and delivery systems of the 24 industrialized member countries of the Organization for Economic Cooperation and Development (OECD). U.S. health expenditure performance is compared with the performance of other OECD countries. Thirty-six tables of data from 1960-90 are presented on health expenditures, health care prices, availability and utilization of health care services, health outcomes, and basic economic and demographic factors.</p><p>authors: Greenwald, Leslie M; Poullier, Jean P</p><p>issue_mesh: Aged : Canada : Comparative Study : Cost Control : Data Collection : Delivery of Health Care/economics : Demography : Europe : Female : Health Expenditures/statistics &#x26; numerical data : Health Policy/economics : Health Resources/utilization : Health Status Indicators : Human : Infant, Newborn : International Agencies : Japan : Male : Middle Age : United States</p><p>issue_number: 4</p><p>ntis_number: PB2001-105740</p><p>page_range: 1-80</p><p>primary_author: Schieber, George J</p><p>title: U.S. health expenditure performance: an international comparison and data update.</p><p>volume: 13</p><p>year_period: 1992 Summer</p>]]></description></item><item><title>What does the Consumer Price Index for prescription drugs really measure?</title><pubDate>Mon, 04 Nov 2019 02:27:06 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191206</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191206</guid><description><![CDATA[<p>abstract: This article examines the conceptually desirable attributes of a fully quality-adjusted prescription drug price index. It provides an understanding of how the Consumer Price Index for prescription drugs and medical supplies treats quality changes in prescription drugs and, in particular, quality changes associated with the introduction of new drugs.</p><p>authors: Goepfrich, Valy T; Weisbrod, Burton A</p><p>issue_mesh: Abstracting and Indexing : Data Interpretation, Statistical : Drug Costs/classification/statistics &#x26; numerical data : Human : Models, Econometric : Prescriptions, Drug/economics : Quality Control : Support, U.S. Gov't, P.H.S. : United States</p><p>issue_number: 3</p><p>ntis_number: PB2001-105738</p><p>page_range: 45-51</p><p>primary_author: Cleeton, David L</p><p>title: What does the Consumer Price Index for prescription drugs really measure?</p><p>volume: 13</p><p>year_period: 1992 Spring</p>]]></description></item><item><title>Purpose of admission and resource use during cancer hospitalizations.</title><pubDate>Mon, 04 Nov 2019 02:27:06 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191196</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191196</guid><description><![CDATA[<p>abstract: This study examined the role of purpose of admission (POA) in hospitalizations for lung, colon, and breast cancers, using the 1985 20-percent Medicare provider analysis and review file. Six POA categories were created from discharge abstract data. Average hospitalization charges, per diem charges, length of stay, and rates of death varied significantly by POA (p </p><p>authors: Bergman, Andrew; Drews, Reed E; Henderson, Mary G</p><p>issue_mesh: Decision Support Techniques : Aged : Breast Neoplasms/classification/economics/therapy : Catastrophic Illness/economics : Colonic Neoplasms/classification/economics/therapy : Diagnosis-Related Groups/statistics &#x26; numerical data : Fees and Charges/statistics &#x26; numerical data : Health Resources/utilization : Health Services Research : Human : Lung Neoplasms/classification/economics/therapy : Medicare/statistics &#x26; numerical data/utilization : Neoplasms/classification/economics/therapy : Oncology Service, Hospital/classification/utilization : Palliative Care : Patient Admission/economics/statistics &#x26; numerical data : Support, U.S. Gov't, Non-P.H.S. : United States</p><p>issue_number: 2</p><p>ntis_number: PB92-167279</p><p>page_range: 29-40</p><p>primary_author: Iezzoni, Lisa I</p><p>title: Purpose of admission and resource use during cancer hospitalizations.</p><p>volume: 13</p><p>year_period: 1991 Winter</p>]]></description></item><item><title>Hospital financing reform and case-mix measurement: an international review.</title><pubDate>Mon, 04 Nov 2019 02:27:06 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191216</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191216</guid><description><![CDATA[<p>abstract: A review of reforms in the financing of hospital services in eight European countries and Australia reveals a commitment to a common objective of relating resource use to hospital workload by means of a standardized case-mix framework in the pursuit of greater efficiency. While this objective is also shared with the U.S. prospective payment system (PPS), it is noteworthy that the majority of countries reviewed favor a global budgeting approach to financing hospital services. Ongoing evaluation of these reforms should facilitate an assessment of the merits of case-mix adjusted global budgeting relative to the patient-based alternative.</p><p>authors: N/A</p><p>issue_mesh: Financial Management, Hospital : Australia : Budgets/organization &#x26; administration : Comparative Study : Cost Control/methods : Diagnosis-Related Groups/economics : Europe : Health Resources/economics/supply &#x26; distribution : Insurance, Hospitalization/statistics &#x26; numerical data : Medicare/economics : National Health Programs/economics : Prospective Payment System/economics : Quality Assurance, Health Care/organization &#x26; administration : United States</p><p>issue_number: 4</p><p>ntis_number: PB2001-105740</p><p>page_range: 119-133</p><p>primary_author: Wiley, Miriam M</p><p>title: Hospital financing reform and case-mix measurement: an international review.</p><p>volume: 13</p><p>year_period: 1992 Summer</p>]]></description></item><item><title>Cost and volume trends in health care facility construction.</title><pubDate>Mon, 04 Nov 2019 02:27:05 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191106</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191106</guid><description><![CDATA[<p>abstract: In 1987, the Health Care Financing Administration proposed adding capital cost reimbursement to the prospective payment system. A data base was developed from which an index was calculated to adjust for geographic variation in construction cost. Findings from the data base, along with a description of trends in health care facility construction from 1970 through 1986, are presented. Spending (in constant 1986 dollars) and volume of health care facility construction declined from 1970 to 1986. Construction cost per square foot increased until 1983, followed by a decline to pre-1980 levels after the 1983 implementation of the prospective payment system.</p><p>authors: N/A</p><p>issue_mesh: Databases, Factual : Prospective Payment System : Abstracting and Indexing : Costs and Cost Analysis/statistics &#x26; numerical data : Financing, Construction/trends : Hospital Design and Construction/economics : Medicare Part A/statistics &#x26; numerical data : Support, Non-U.S. Gov't : United States : United States Health Care Financing Administration</p><p>issue_number: 4</p><p>ntis_number: PB91-105973</p><p>page_range: 87-102</p><p>primary_author: England, William L</p><p>title: Cost and volume trends in health care facility construction.</p><p>volume: 11</p><p>year_period: 1990 Summer</p>]]></description></item><item><title>Swing-bed services under the Medicare program, 1984-87.</title><pubDate>Mon, 04 Nov 2019 02:27:05 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191098</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191098</guid><description><![CDATA[<p>abstract: Under Medicare, swing beds are beds that can be used by small rural hospitals to furnish both acute and post-acute care. The swing-bed program was instituted under the provisions of the Omnibus Reconciliation Act of 1980 (Public Law 96-499). Under Medicare, post-acute care in the hospital would be covered as services equivalent to skilled nursing facility level of care. Data show that the program has had a rapid rate of growth. By 1987, swing beds accounted for 9.7 percent of the admissions to skilled nursing facility services, 6.0 percent of the covered days of care, and 6.2 percent of the reimbursements. Over one-half of the swing-bed services are furnished in the North Central States.</p><p>authors: N/A</p><p>issue_mesh: Hospitals : Bed Conversion/statistics &#x26; numerical data : Health Facility Planning/statistics &#x26; numerical data : Hospitals, Rural/economics : Medicare/statistics &#x26; numerical data : Skilled Nursing Facilities/economics : United States</p><p>issue_number: 3</p><p>ntis_number: PB90-258153</p><p>page_range: 99-106</p><p>primary_author: Silverman, Herbert A</p><p>title: Swing-bed services under the Medicare program, 1984-87.</p><p>volume: 11</p><p>year_period: 1990 Spring</p>]]></description></item><item><title>Recent changes in service use patterns of disabled Medicare beneficiaries.</title><pubDate>Mon, 04 Nov 2019 02:27:05 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191094</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191094</guid><description><![CDATA[<p>abstract: An analysis was made of the pre- and post-patterns of Medicare Part A service use using the samples of the 1982 and 1984 National Long-Term Care Surveys linked to the Medicare Part A bill files and mortality reports. The analysis was conducted both for the total elderly Medicare beneficiary population and for the community resident disabled population--a group felt to be particularly vulnerable to any adverse effect of the prospective payment system's induced change in service use. The expected changes in Medicare service patterns were identified, but there was no evidence of adverse changes in outcome--even for select vulnerable populations.</p><p>authors: Liu, Korbin</p><p>issue_mesh: Aged : Chronic Disease : Continuity of Patient Care/statistics &#x26; numerical data : Data Collection : Disabled Persons/statistics &#x26; numerical data : Evaluation Studies : Human : Long-Term Care/utilization : Medicare/statistics &#x26; numerical data : Multivariate Analysis : National Center for Health Statistics (U.S.) : Prospective Payment System/trends : Support, U.S. Gov't, Non-P.H.S. : Support, U.S. Gov't, P.H.S. : United States</p><p>issue_number: 3</p><p>ntis_number: PB90-258153</p><p>page_range: 51-66</p><p>primary_author: Manton, Kenneth G</p><p>title: Recent changes in service use patterns of disabled Medicare beneficiaries.</p><p>volume: 11</p><p>year_period: 1990 Spring</p>]]></description></item><item><title>Use and cost of short-stay hospital inpatient services under Medicare, 1988.</title><pubDate>Mon, 04 Nov 2019 02:27:05 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191140</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191140</guid><description><![CDATA[<p>abstract: In this article, data are presented on trends in the use of and program payments for inpatient short-stay hospital services to Medicare beneficiaries. The data on the services used by aged and disabled Medicare beneficiaries are presented for the years 1972 through 1988. The discussion is focused on trends in utilization and program payments resulting from the implementation of the Medicare prospective payment system. The State data for 1988 consist of utilization and program payment statistics by the residence of the beneficiaries in urban and rural areas. This is the first time that inpatient hospital data have been presented in this manner.</p><p>authors: Keene, Roger E</p><p>issue_mesh: Aged : Data Collection : Disabled Persons/statistics &#x26; numerical data : Health Expenditures/statistics &#x26; numerical data : Hospitalization/trends : Hospitals/utilization : Human : Inpatients/classification : Length of Stay/trends : Medicare/statistics &#x26; numerical data : Patient Discharge/trends : Prospective Payment System : United States</p><p>issue_number: 1</p><p>ntis_number: PB91-176255</p><p>page_range: 91-99</p><p>primary_author: Latta, Viola B</p><p>title: Use and cost of short-stay hospital inpatient services under Medicare, 1988.</p><p>volume: 12</p><p>year_period: 1990 Fall</p>]]></description></item><item><title>Medicaid home and community-based waivers for acquired immunodeficiency syndrome patients.</title><pubDate>Mon, 04 Nov 2019 02:27:05 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191124</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191124</guid><description><![CDATA[<p>ntis_number: PB91-176248</p><p>page_range: 109-118</p><p>primary_author: Lindsey, Phoebe A</p><p>title: Medicaid home and community-based waivers for acquired immunodeficiency syndrome patients.</p><p>volume: Supp.</p><p>year_period: 1990 Supp.</p>]]></description></item><item><title>Toward a prospective payment system for ambulatory surgery.</title><pubDate>Mon, 04 Nov 2019 02:27:05 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191096</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191096</guid><description><![CDATA[<p>abstract: In this article, ambulatory surgery among the aged Medicare population in 1985 is examined. Total hospital facility charges for ambulatory surgery in that year were estimated at $1.8 billion, with about one-half of that amount involving cataract surgery. The possibility of using diagnosis-related groups for a prospective payment system for ambulatory surgery was examined and was rejected for two reasons: (1) about 20 percent of the dollar volume of hospital-based ambulatory surgery fell into medical diagnosis-related groups and (2) the ratio of inpatient diagnosis-related group weight to outpatient billed charges for the ambulatory procedures falling into a given diagnosis-related group varied more than tenfold, making diagnosis-related group weights impossible to use in a consistent manner. A newly developed version of ambulatory visit groups and the even newer ambulatory patient groups were then considered as an alternative for a prospective payment system. These are briefly described.</p><p>authors: Collard, Ann F; Malbon, Alan; Mowschenson, Peter; Vertrees, James C</p><p>issue_mesh: Aged : Ambulatory Surgical Procedures/economics : Data Collection : Diagnosis-Related Groups/economics/statistics &#x26; numerical data : Evaluation Studies : Human : Medicare/organization &#x26; administration : Prospective Payment System/organization &#x26; administration : Rate Setting and Review/methods : Support, U.S. Gov't, Non-P.H.S. : United States</p><p>issue_number: 3</p><p>ntis_number: PB90-258153</p><p>page_range: 79-86</p><p>primary_author: Lion, Joanna</p><p>title: Toward a prospective payment system for ambulatory surgery.</p><p>volume: 11</p><p>year_period: 1990 Spring</p>]]></description></item><item><title>Comparison of alternative weight recalibration methods for diagnosis-related groups.</title><pubDate>Mon, 04 Nov 2019 02:27:05 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191148</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191148</guid><description><![CDATA[<p>abstract: In this article, alternative methodologies for recalibration of the diagnosis-related group (DRG) weights are examined. Based on 1984 data, cost and charge-based weights are less congruent than those calculated with 1981 data. Previous studies using 1981 data demonstrated that cost- and charge-based weights were not very different. Charge weights result in higher payments to surgical DRGs and lower payments to medical DRGs, relative to cost weights. At the provider level, charge weights result in higher payments to large urban hospitals and teaching hospitals, relative to cost weights.</p><p>authors: Byrne, Daniel J</p><p>issue_mesh: Prospective Payment System : Ancillary Services, Hospital/economics : Comparative Study : Cost Allocation/methods : Diagnosis-Related Groups/economics : Methods : Rate Setting and Review/methods : Relative Value Scales : Support, U.S. Gov't, Non-P.H.S. : United States</p><p>issue_number: 2</p><p>ntis_number: PB91-176263</p><p>page_range: 87-101</p><p>primary_author: Rogowski, Jeannette R</p><p>title: Comparison of alternative weight recalibration methods for diagnosis-related groups.</p><p>volume: 12</p><p>year_period: 1990 Winter</p>]]></description></item><item><title>Medicaid: challenges and opportunities.</title><pubDate>Mon, 04 Nov 2019 02:27:05 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191114</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191114</guid><description><![CDATA[<p>ntis_number: PB91-176248</p><p>page_range: 5-8</p><p>primary_author: Tallon Jr, James R</p><p>title: Medicaid: challenges and opportunities.</p><p>volume: Supp.</p><p>year_period: 1990 Supp.</p>]]></description></item><item><title>Reform of health care in Germany.</title><pubDate>Mon, 04 Nov 2019 02:27:05 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191160</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191160</guid><description><![CDATA[<p>abstract: For the past 45 years Germany has had two health care systems: one in the former Federal Republic of Germany and one in the former German Democratic Republic. The system in the Federal Republic was undergoing some important reforms when German reunification took place in October 1990. Now the system in eastern Germany is undergoing a major transformation to bring it more into line with that in western Germany.</p><p>authors: N/A</p><p>issue_mesh: Comparative Study : Cost Control/legislation &#x26; jurisprudence : Delivery of Health Care/legislation &#x26; jurisprudence/organization &#x26; administration : Evaluation Studies : Germany, East : Germany, West : Government : Health Planning/legislation &#x26; jurisprudence : Insurance, Health/legislation &#x26; jurisprudence/organization &#x26; administration : Interinstitutional Relations : Legislation, Hospital : Models, Theoretical : National Health Programs : Support, Non-U.S. Gov't</p><p>issue_number: 3</p><p>ntis_number: PB91-201384</p><p>page_range: 73-86</p><p>primary_author: Hurst, Jeremy</p><p>title: Reform of health care in Germany.</p><p>volume: 12</p><p>year_period: 1991 Spring</p>]]></description></item><item><title>Health care indicators. Community hospital statistics; employment, hours, and earnings in the private sector; health care prices; and national economic indicators.</title><pubDate>Mon, 04 Nov 2019 02:27:05 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191100</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191100</guid><description><![CDATA[<p>authors: Maple, Brenda T</p><p>issue_mesh: Data Collection : Employment/statistics &#x26; numerical data : Health Services/statistics &#x26; numerical data : Home Care Services/statistics &#x26; numerical data : Hospitals, Community/statistics &#x26; numerical data : Inflation, Economic/statistics &#x26; numerical data : Prospective Payment System/statistics &#x26; numerical data : Skilled Nursing Facilities/statistics &#x26; numerical data : United States</p><p>issue_number: 3</p><p>ntis_number: PB90-258153</p><p>page_range: 113-132</p><p>primary_author: Donham, Carolyn S</p><p>title: Health care indicators. Community hospital statistics; employment, hours, and earnings in the private sector; health care prices; and national economic indicators.</p><p>volume: 11</p><p>year_period: 1990 Spring</p>]]></description></item><item><title>Volume and intensity of Medicare physicians' services: an overview.</title><pubDate>Mon, 04 Nov 2019 02:27:05 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191108</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191108</guid><description><![CDATA[<p>abstract: From 1978 to 1987, Medicare spending for physicians' services increased at annual compound rates of 16 percent, far exceeding increases expected based on inflation and increases in beneficiaries. As a result, Medicare spending for Part B physicians' services has attracted considerable attention. This article contains an overview of expenditure trends for Part B physicians' services, a summary of recent research findings on issues related to volume and intensity of physicians' services, and a discussion of options for controlling volume and intensity. The possible impact of the recently enacted relative-value-based free schedule on volume and intensity of services is discussed briefly.</p><p>authors: N/A</p><p>issue_mesh: Cost Control/methods : Health Expenditures/trends : Medicare Part B/statistics &#x26; numerical data : Physician's Practice Patterns/statistics &#x26; numerical data : Relative Value Scales : United States</p><p>issue_number: 4</p><p>ntis_number: PB91-105973</p><p>page_range: 133-146</p><p>primary_author: Kay, Terrence L</p><p>title: Volume and intensity of Medicare physicians' services: an overview.</p><p>volume: 11</p><p>year_period: 1990 Summer</p>]]></description></item><item><title>A reassessment of hospital product and productivity changes over time.</title><pubDate>Mon, 04 Nov 2019 02:27:05 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191104</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191104</guid><description><![CDATA[<p>abstract: Were the changes found in the first year of the prospective payment system (PPS) one-time changes that attenuated as hospitals gained familiarity with the system? The results of this research show that, over time, discharges to home (self-care) continued to decrease, discharges to home health agencies continued to increase, but transfers and discharges to skilled nursing facilities or intermediate care facilities accounted for an increasing share of total discharges. After a dramatic decrease in the first year, the use of laboratory tests, diagnostic tests, and X-rays returned, over time, almost to pre-PPS levels.</p><p>authors: Chesney, James D; Fleming, Steven T</p><p>issue_mesh: Prospective Payment System : Efficiency : Evaluation Studies : Financial Management, Hospital/trends : Hospitals, Community/utilization : Medicare/statistics &#x26; numerical data : Models, Theoretical : Patient Discharge/statistics &#x26; numerical data : Product Line Management : United States</p><p>issue_number: 4</p><p>ntis_number: PB91-105973</p><p>page_range: 69-77</p><p>primary_author: Long, Michael J</p><p>title: A reassessment of hospital product and productivity changes over time.</p><p>volume: 11</p><p>year_period: 1990 Summer</p>]]></description></item><item><title>Analysis of nursing home capital reimbursement systems.</title><pubDate>Mon, 04 Nov 2019 02:27:04 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191158</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191158</guid><description><![CDATA[<p>abstract: An increasing number of States are using a fair-rental approach for reimbursement of nursing home capital costs. In this study, two variants of the fair-rental capital-reimbursement approach are compared with the traditional cost-based approach in terms of after-tax cash flow to the investor, cost to the State, and rate of return to investor. Simulation models were developed to examine the effects of each capital-reimbursement approach both at specific points in time and over various periods of time. Results indicate that although long-term costs were similar for the three systems, both fair-rental approaches may be superior to the traditional cost-based approach in promoting and controlling industry stability and, at the same time, in providing an adequate return to investors.</p><p>authors: Carlough, Tom; Schlenker, Robert E</p><p>issue_mesh: Reimbursement Mechanisms : Accounts Payable and Receivable : Capital Financing/economics : Costs and Cost Analysis : Depreciation : Health Facilities, Proprietary/economics : Investments/economics : Leasing, Property/economics : Medicaid/organization &#x26; administration : Models, Theoretical : Nursing Homes/economics : State Health Plans/economics : Support, Non-U.S. Gov't : Support, U.S. Gov't, Non-P.H.S. : United States</p><p>issue_number: 3</p><p>ntis_number: PB91-201384</p><p>page_range: 53-60</p><p>primary_author: Boerstler, Heidi</p><p>title: Analysis of nursing home capital reimbursement systems.</p><p>volume: 12</p><p>year_period: 1991 Spring</p>]]></description></item><item><title>Hospital back-up days: impact on joint Medicare and Medicaid beneficiaries.</title><pubDate>Mon, 04 Nov 2019 02:27:04 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191146</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191146</guid><description><![CDATA[<p>abstract: In this article the question of whether nursing home market characteristics affect the ability of hospitals to discharge patients to nursing homes is examined. Also examined is the question of whether joint Medicare and Medicaid beneficiaries have a more difficult time being placed than do other patients. The principal conclusions are first, that the nursing home bed supply and the type of Medicaid payment system affect the ability of hospitals to discharge patients to nursing homes. Joint Medicare and Medicaid beneficiaries have a more difficult time being placed in nursing homes in States with fewer beds and more restrictive Medicaid payment policies, and joint beneficiaries do not appear to have longer stays in hospitals. Rather, they have a greater likelihood of being discharged to home.</p><p>authors: N/A</p><p>issue_mesh: Health Services Accessibility : Home Care Services/statistics &#x26; numerical data : Length of Stay/statistics &#x26; numerical data : Medicaid/statistics &#x26; numerical data : Medicare/statistics &#x26; numerical data : Nursing Homes/supply &#x26; distribution : Patient Discharge/statistics &#x26; numerical data : Prospective Payment System/statistics &#x26; numerical data : United States</p><p>issue_number: 2</p><p>ntis_number: PB91-176263</p><p>page_range: 67-73</p><p>primary_author: Holahan, John</p><p>title: Hospital back-up days: impact on joint Medicare and Medicaid beneficiaries.</p><p>volume: 12</p><p>year_period: 1990 Winter</p>]]></description></item><item><title>Medicaid and third-party liability: using information to achieve program goals.</title><pubDate>Mon, 04 Nov 2019 02:27:04 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191120</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191120</guid><description><![CDATA[<p>ntis_number: PB91-176248</p><p>page_range: 69-73</p><p>primary_author: Buzzard, Kenneth</p><p>title: Medicaid and third-party liability: using information to achieve program goals.</p><p>volume: Supp.</p><p>year_period: 1990 Supp.</p>]]></description></item><item><title>Prospective payment system and other effects on post-hospital services.</title><pubDate>Mon, 04 Nov 2019 02:27:04 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191144</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191144</guid><description><![CDATA[<p>abstract: The effects of the prospective payment system and other factors on the use of post-hospital services were investigated for four groups of diagnostically related Medicare discharges. Effects on specific services and total Medicare payments were analyzed at the beneficiary level using a Tobit regression technique. The utilization data base consisted of more than 30,000 discharge episode records for the years 1981-86. The post-hospital period for each Medicare beneficiary encompassed the 60 days following discharge from the hospital. Influences on both the level and timing of health care services during this period were appraised. The influence of the prospective payment system was measured through the financial impact and risk that it imposed on the discharging hospital.</p><p>authors: N/A</p><p>issue_mesh: Aftercare/utilization : Durable Medical Equipment/utilization : Home Care Services/utilization : Human : Medicare/statistics &#x26; numerical data : Patient Discharge/statistics &#x26; numerical data : Prospective Payment System/statistics &#x26; numerical data : Regression Analysis : Skilled Nursing Facilities/utilization : United States</p><p>issue_number: 2</p><p>ntis_number: PB91-176263</p><p>page_range: 37-54</p><p>primary_author: Gianfrancesco, Frank D</p><p>title: Prospective payment system and other effects on post-hospital services.</p><p>volume: 12</p><p>year_period: 1990 Winter</p>]]></description></item><item><title>Access to Medicaid and Medicare by the low-income disabled.</title><pubDate>Mon, 04 Nov 2019 02:27:04 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191126</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191126</guid><description><![CDATA[<p>ntis_number: PB91-176248</p><p>page_range: 133-148</p><p>primary_author: Ellwood, Marilyn R</p><p>title: Access to Medicaid and Medicare by the low-income disabled.</p><p>volume: Supp.</p><p>year_period: 1990 Supp.</p>]]></description></item><item><title>Use of Medicare-covered home health agency services, 1988.</title><pubDate>Mon, 04 Nov 2019 02:27:04 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191150</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191150</guid><description><![CDATA[<p>abstract: From 1974 through 1983, Medicare-covered home health visits and expenditures increased at double digit rates (18.4 and 29.0 percent annually, respectively). During the period from 1984 through 1987, intensified bill review by fiscal intermediaries and increased denial rates led to a decline in the number of home health visits. New reimbursement policies led to a markedly reduced rate of increase in the payments for home health services. By 1988, the use of and expenditures for home health services resumed rising. In this article, the trends in home health service use and expenditures are presented and the changes in legislation and policies that affected them are discussed.</p><p>authors: N/A</p><p>issue_mesh: Data Collection : Home Care Services/economics/utilization : Insurance, Health, Reimbursement/trends : Medicare/statistics &#x26; numerical data : United States</p><p>issue_number: 2</p><p>ntis_number: PB91-176263</p><p>page_range: 113-126</p><p>primary_author: Silverman, Herbert A</p><p>title: Use of Medicare-covered home health agency services, 1988.</p><p>volume: 12</p><p>year_period: 1990 Winter</p>]]></description></item><item><title>Health expenditures in major industrialized countries, 1960-87.</title><pubDate>Mon, 04 Nov 2019 02:27:04 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191110</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191110</guid><description><![CDATA[<p>abstract: In this article, levels and changes in health care expenditures for Canada, France, the Federal Republic of Germany, Italy, Japan, the United Kingdom, and the United States are analyzed. First, the levels and changes in the share of gross domestic product (GDP) devoted to health are reviewed in terms of the health-to-GDP ratio, nominal health expenditure and GDP growth, and changes in population and prices. Second, absolute levels of health spending denominated in U.S. dollars are compared over time. Finally, some concluding observations are made.</p><p>authors: N/A</p><p>issue_mesh: Canada : Comparative Study : Economics, Hospital/trends : Economics, Medical/trends : Europe : Health Expenditures/statistics &#x26; numerical data : Health Services/economics : Japan : Statistics : United States</p><p>issue_number: 4</p><p>ntis_number: PB91-105973</p><p>page_range: 159-167</p><p>primary_author: Schieber, George J</p><p>title: Health expenditures in major industrialized countries, 1960-87.</p><p>volume: 11</p><p>year_period: 1990 Summer</p>]]></description></item><item><title>Trends in Medicaid payments and utilization, 1975-89.</title><pubDate>Mon, 04 Nov 2019 02:27:04 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191116</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191116</guid><description><![CDATA[<p>ntis_number: PB91-176248</p><p>page_range: 15-33</p><p>primary_author: Reilly, Thomas W</p><p>title: Trends in Medicaid payments and utilization, 1975-89.</p><p>volume: Supp.</p><p>year_period: 1990 Supp.</p>]]></description></item><item><title>Structure and performance of health maintenance organizations: a review.</title><pubDate>Mon, 04 Nov 2019 02:27:04 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191138</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191138</guid><description><![CDATA[<p>abstract: During the past decade, the number of and enrollment in health maintenance organizations (HMOs) have grown dramatically. In 1980, 236 HMOs served 9 million members. By 1989, there were 591 HMOs with over 34 million enrollees. New HMOs are very different in organizational structure and arrangements than the HMOs that were operating in the 1970s, and the health care markets they serve also have changed substantially with the increasing supply of physicians and declining hospital admissions. Consequently, the accepted research findings on HMO performance in the 1970s may have only limited usefulness in understanding the role of HMOs and their effect on today's market for health services. This is of particular concern as the Health Care Financing Administration considers the further expansion of managed care options available to Medicare and Medicaid beneficiaries. In this article, the author reviews evidence on the relationship between HMO organizational arrangements and performance, and the trends within the HMO industry toward new organizational structures. The implications for Medicare and Medicaid risk contracting are also examined.</p><p>authors: N/A</p><p>issue_mesh: Health Maintenance Organizations/organization &#x26; administration : Health Services Research : Medicare : Models, Theoretical : Organizational Affiliation : Physician's Practice Patterns : Support, U.S. Gov't, Non-P.H.S. : United States : Utilization Review/methods</p><p>issue_number: 1</p><p>ntis_number: PB91-176255</p><p>page_range: 71-79</p><p>primary_author: Langwell, Kathryn M</p><p>title: Structure and performance of health maintenance organizations: a review.</p><p>volume: 12</p><p>year_period: 1990 Fall</p>]]></description></item><item><title>Accessibility and effectiveness of care under Medicaid.</title><pubDate>Mon, 04 Nov 2019 02:27:04 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191118</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191118</guid><description><![CDATA[<p>ntis_number: PB91-176248</p><p>page_range: 47-56</p><p>primary_author: Jencks, Stephen F</p><p>title: Accessibility and effectiveness of care under Medicaid.</p><p>volume: Supp.</p><p>year_period: 1990 Supp.</p>]]></description></item><item><title>Institutional alternatives to the rural hospital.</title><pubDate>Mon, 04 Nov 2019 02:27:04 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191097</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191097</guid><description><![CDATA[<p>abstract: An important aspect of the ongoing debate on rural health policy is how to deliver inpatient care in sparsely populated rural areas. One alternative is to create a new classification of rural inpatient facility that would deliver more limited services than available in a rural hospital, have more flexibility in staffing requirements, and possibly be reimbursed differently. The support of the Health Care Financing Administration for the concept of a limited service rural hospital is critical, since such a facility would not be financially viable without Medicare payment. Several organizational and public policy issues that merit consideration in the design and implementation of institutional alternatives to rural hospitals are discussed, including licensure and certification, scope of services, personnel, quality assurance, and payment.</p><p>authors: Moscovice, Ira S; Wellever, Anthony L; Wingert, Terence D</p><p>issue_mesh: Hospital Administration : Hospital Restructuring : Hospitals : Hospitals, Rural/organization &#x26; administration : Licensure, Hospital : Medically Underserved Area : Medicare/organization &#x26; administration : Montana : Organizational Innovation : Personnel Staffing and Scheduling : Pilot Projects : Quality of Health Care : Support, U.S. Gov't, Non-P.H.S. : United States</p><p>issue_number: 3</p><p>ntis_number: PB90-258153</p><p>page_range: 87-97</p><p>primary_author: Christianson, Jon B</p><p>title: Institutional alternatives to the rural hospital.</p><p>volume: 11</p><p>year_period: 1990 Spring</p>]]></description></item><item><title>Leading inpatient surgical procedures for aged Medicare beneficiaries, 1987.</title><pubDate>Mon, 04 Nov 2019 02:27:04 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191087</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191087</guid><description><![CDATA[<p>abstract: Medicare program data on utilization and charges for short-stay hospital inpatient services are presented. The focus of this article is on trends in total and surgical discharges for selected years (1977-87) and highlights of regional variations in the most frequently reported (leading) surgical procedures performed on aged Medicare hospital insurance beneficiaries during 1987.</p><p>authors: Keene, Roger E</p><p>issue_mesh: Aged : Fees and Charges : Health Expenditures/statistics &#x26; numerical data : Human : Length of Stay/statistics &#x26; numerical data : Medicare/statistics &#x26; numerical data : Patient Discharge/statistics &#x26; numerical data : Surgical Procedures, Operative/utilization : United States/epidemiology</p><p>issue_number: 2</p><p>ntis_number: PB90-204629</p><p>page_range: 99-110</p><p>primary_author: Latta, Viola B</p><p>title: Leading inpatient surgical procedures for aged Medicare beneficiaries, 1987.</p><p>volume: 11</p><p>year_period: 1989 Winter</p>]]></description></item><item><title>Deciphering Medicaid data: issues and needs.</title><pubDate>Mon, 04 Nov 2019 02:27:04 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191117</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191117</guid><description><![CDATA[<p>ntis_number: PB91-176248</p><p>page_range: 35-45</p><p>primary_author: Ku, Leighton</p><p>title: Deciphering Medicaid data: issues and needs.</p><p>volume: Supp.</p><p>year_period: 1990 Supp.</p>]]></description></item><item><title>Addendum: a brief summary of the Medicaid program.</title><pubDate>Mon, 04 Nov 2019 02:27:04 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191130</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191130</guid><description><![CDATA[<p>ntis_number: PB91-176248</p><p>page_range: 171-172</p><p>primary_author: Waid, Mary O</p><p>title: Addendum: a brief summary of the Medicaid program.</p><p>volume: Supp.</p><p>year_period: 1990 Supp.</p>]]></description></item><item><title>Functionally and medically defined subgroups of nursing home populations.</title><pubDate>Mon, 04 Nov 2019 02:27:04 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191136</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191136</guid><description><![CDATA[<p>abstract: The functional and health characteristics of nursing home residents in New York State using a multivariate classification procedure are examined in this article. This analysis suggested that these characteristics could be explained in terms of six dimensions. The association of these six dimensions with two existing sets of nursing home case-mix groups was analyzed in order to determine how groups based only on the health and functional characteristics of residents related to groups based primarily on measures of current service use. A number of resident characteristics were not described well by case-mix measures based only on service use, suggesting the need to modify such groups using additional sources of input.</p><p>authors: Vertrees, James C; Woodbury, Max A</p><p>issue_mesh: Activities of Daily Living : Aged : Diagnosis-Related Groups/statistics &#x26; numerical data : Health Resources/utilization : Human : Inpatients/classification : Long-Term Care/classification : Models, Statistical : New York : Nursing Homes/utilization : Support, U.S. Gov't, Non-P.H.S. : Support, U.S. Gov't, P.H.S.</p><p>issue_number: 1</p><p>ntis_number: PB91-176255</p><p>page_range: 47-62</p><p>primary_author: Manton, Kenneth G</p><p>title: Functionally and medically defined subgroups of nursing home populations.</p><p>volume: 12</p><p>year_period: 1990 Fall</p>]]></description></item><item><title>Hospital outpatient services under Medicare, 1987.</title><pubDate>Mon, 04 Nov 2019 02:27:02 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191109</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191109</guid><description><![CDATA[<p>abstract: Presented in this article are data related to hospital outpatient services provided for aged and disabled Medicare beneficiaries during calendar year 1987. Trend data are also presented for selected calendar years 1974-87. Hospital outpatient covered charges and Medicare program payments (in total and per enrollee) are the statistics employed to measure the use of hospital outpatient services. The data contained in this article should provide information to help identify trends and patterns of care for monitoring the Medicare hospital outpatient services.</p><p>authors: Keene, Roger E; Latta, Viola B</p><p>issue_mesh: Aged : Data Collection : Emergency Service, Hospital/utilization : Human : Medicare/statistics &#x26; numerical data : Outpatient Clinics, Hospital/utilization : Statistics : United States</p><p>issue_number: 4</p><p>ntis_number: PB91-105973</p><p>page_range: 147-158</p><p>primary_author: Helbing, Charles</p><p>title: Hospital outpatient services under Medicare, 1987.</p><p>volume: 11</p><p>year_period: 1990 Summer</p>]]></description></item><item><title>Medicaid prospective payment: case-mix increase.</title><pubDate>Mon, 04 Nov 2019 02:27:02 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191137</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191137</guid><description><![CDATA[<p>abstract: South Carolina Medicaid implemented prospective payment by diagnosis-related group (DRG) for inpatient care. The rate of complications among newborns and deliveries doubled immediately. The case-mix index for newborns increased 66.6 percent, which increased the total Medicaid hospital expenditure 5.5 percent. Outlier payments increased total expenditure further. DRG distribution change among newborns has a large impact on spending because newborn complication DRGs have high weights. States adopting a DRG-based payment system for Medicaid should anticipate a greater increase in case mix than Medicare experienced.</p><p>authors: Kronenfeld, Jennie J</p><p>issue_mesh: Abstracting and Indexing : Cesarean Section/utilization : Comorbidity : Diagnosis-Related Groups/trends : Female : Hospitalization/statistics &#x26; numerical data : Human : Infant, Newborn : Medicaid/utilization : Outliers, DRG : Pregnancy : Prospective Payment System/statistics &#x26; numerical data : South Carolina : State Health Plans : United States</p><p>issue_number: 1</p><p>ntis_number: PB91-176255</p><p>page_range: 63-70</p><p>primary_author: Baker, Samuel L</p><p>title: Medicaid prospective payment: case-mix increase.</p><p>volume: 12</p><p>year_period: 1990 Fall</p>]]></description></item><item><title>Medicaid-financed residential care for persons with mental retardation.</title><pubDate>Mon, 04 Nov 2019 02:27:02 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191127</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191127</guid><description><![CDATA[<p>ntis_number: PB91-176248</p><p>page_range: 149-160</p><p>primary_author: Lakin, K Charles</p><p>title: Medicaid-financed residential care for persons with mental retardation.</p><p>volume: Supp.</p><p>year_period: 1990 Supp.</p>]]></description></item><item><title>Illness-episode approach: costs and benefits of medigap insurance.</title><pubDate>Mon, 04 Nov 2019 02:27:02 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191107</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191107</guid><description><![CDATA[<p>abstract: Over two-thirds of Medicare beneficiaries have private supplementary coverage, but few know enough about Medicare, their own supplements, or available alternatives to make intelligent comparisons and informed purchasing decisions. The illness-episode approach, a new way to provide insurance information to Medicare beneficiaries, calculates out-of-pocket costs likely to be faced by beneficiaries experiencing 13 illnesses, under Medicare alone and under different medigap policies. Applying the approach to six policies marketed in Los Angeles in 1986 revealed that plans varied widely in their ability to reduce financial vulnerability; many still leave the elderly with substantial out-of-pocket costs.</p><p>authors: Davidson, Bruce N</p><p>issue_mesh: Deductibles and Coinsurance : Insurance Benefits : Consumer Participation/economics : Costs and Cost Analysis : Economics, Hospital/statistics &#x26; numerical data : Economics, Medical/statistics &#x26; numerical data : Evaluation Studies : Financing, Personal : Los Angeles : Medicare/economics : Support, U.S. Gov't, Non-P.H.S. : United States</p><p>issue_number: 4</p><p>ntis_number: PB91-105973</p><p>page_range: 121-131</p><p>primary_author: Sofaer, Shoshanna</p><p>title: Illness-episode approach: costs and benefits of medigap insurance.</p><p>volume: 11</p><p>year_period: 1990 Summer</p>]]></description></item><item><title>Ambulatory practice variation in Maryland: implications for Medicaid cost management.</title><pubDate>Mon, 04 Nov 2019 02:27:02 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191119</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191119</guid><description><![CDATA[<p>ntis_number: PB91-176248</p><p>page_range: 57-67</p><p>primary_author: Stuart, Mary</p><p>title: Ambulatory practice variation in Maryland: implications for Medicaid cost management.</p><p>volume: Supp.</p><p>year_period: 1990 Supp.</p>]]></description></item><item><title>Containing health costs in a consumer-based model.</title><pubDate>Mon, 04 Nov 2019 02:27:02 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191177</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191177</guid><description><![CDATA[<p>ntis_number: PB99-106478</p><p>page_range: 21-25</p><p>primary_author: Butler, Stuart M</p><p>title: Containing health costs in a consumer-based model.</p><p>volume: Supp.</p><p>year_period: 1991 Supp.</p>]]></description></item><item><title>All-payer ratesetting: down but not out.</title><pubDate>Mon, 04 Nov 2019 02:27:02 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191179</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191179</guid><description><![CDATA[<p>ntis_number: PB99-106478</p><p>page_range: 35-41; discussion 42-44</p><p>primary_author: Anderson, Gerald F</p><p>title: All-payer ratesetting: down but not out.</p><p>volume: Supp.</p><p>year_period: 1991 Supp.</p>]]></description></item><item><title>Measuring input prices for physicians: the revised Medicare Economic Index.</title><pubDate>Mon, 04 Nov 2019 02:27:02 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191169</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191169</guid><description><![CDATA[<p>abstract: Medicare payments for physician services under Part B were historically restrained by capping prevailing charges using the Medicare Economic Index (MEI). The MEI, an input price index for physician services that incorporates an adjustment for economywide labor productivity, has not undergone a major revision since 1975. The MEI is an important determinant of the annual volume performance standard that will be used to set aggregate increases in the revised system for paying physicians under Medicare beginning in 1992. The MEI will also be used in establishing the annual changes to the payment conversion factors under the new payment system.</p><p>authors: Arnett 3d, Ross H; Brown, Aaron P; Chulis, George S</p><p>issue_mesh: Abstracting and Indexing/economics : Automobiles/economics : Efficiency : Employment/economics : Equipment and Supplies/economics : Health Expenditures/classification : Insurance, Liability/economics : Medicare Part B/classification : Pharmaceutical Preparations : Physicians' Offices/economics : Practice Management, Medical/economics/legislation &#x26; jurisprudence : Salaries and Fringe Benefits : United States</p><p>issue_number: 4</p><p>ntis_number: PB2001-105731</p><p>page_range: 61-73</p><p>primary_author: Freeland, Mark S</p><p>title: Measuring input prices for physicians: the revised Medicare Economic Index.</p><p>volume: 12</p><p>year_period: 1991 Summer</p>]]></description></item><item><title>Geographic variations in Medicare utilization of short-stay hospital services, 1981-88.</title><pubDate>Mon, 04 Nov 2019 02:27:02 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191099</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191099</guid><description><![CDATA[<p>abstract: The change in Federal fiscal year 1984 from cost-based reimbursement to prospective payment at a fixed price for a known and defined product--the hospital stay--represents a fundamental change in the role of the Medicare program within the health care delivery system. In this article, national and selected geographic trends in Medicare short-stay hospital inpatient discharges since 1981 are presented, and they show the impact of the implementation of the prospective payment system.</p><p>authors: Gibson, David A</p><p>issue_mesh: Catchment Area (Health)/statistics &#x26; numerical data : Data Collection : Evaluation Studies : Geography : Hospitals/utilization : Length of Stay/statistics &#x26; numerical data : Medicare/statistics &#x26; numerical data : Patient Discharge/statistics &#x26; numerical data : United States</p><p>issue_number: 3</p><p>ntis_number: PB90-258153</p><p>page_range: 107-111</p><p>primary_author: Edwards, Winston O</p><p>title: Geographic variations in Medicare utilization of short-stay hospital services, 1981-88.</p><p>volume: 11</p><p>year_period: 1990 Spring</p>]]></description></item><item><title>A public health model of Medicaid emergency room use.</title><pubDate>Mon, 04 Nov 2019 02:27:02 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191154</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191154</guid><description><![CDATA[<p>abstract: This study builds a public health model of Medicaid emergency room use for 57 upstate counties in New York from 1985 to 1987. The principle explanatory variables are primary care use (based in physicians' offices, freestanding clinics, and hospital outpatient departments), the concentration of poverty, and geographic and hospital availability. These factors influence the emergency room use of all Medicaid aid categories apart from the Supplemental Security Income recipients. Inherent in these findings are a number of policy implications that are explored in this article.</p><p>authors: Fanning, Thomas R</p><p>issue_mesh: Aid to Families with Dependent Children/utilization : Catchment Area (Health) : Emergency Service, Hospital/utilization : Health Services Misuse/statistics &#x26; numerical data : Medicaid/utilization : Models, Statistical : New York : Poverty Areas : Primary Health Care/utilization : Regression Analysis : Rural Population : United States : Urban Population</p><p>issue_number: 3</p><p>ntis_number: PB91-201384</p><p>page_range: 15-20</p><p>primary_author: deAlteriis, Martin</p><p>title: A public health model of Medicaid emergency room use.</p><p>volume: 12</p><p>year_period: 1991 Spring</p>]]></description></item><item><title>Perspectives on the Medicaid program.</title><pubDate>Mon, 04 Nov 2019 02:27:02 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191113</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191113</guid><description><![CDATA[<p>ntis_number: PB91-176248</p><p>page_range: 2-4</p><p>primary_author: Altman, Drew</p><p>title: Perspectives on the Medicaid program.</p><p>volume: Supp.</p><p>year_period: 1990 Supp.</p>]]></description></item><item><title>Medicaid, the uninsured, and national health spending: federal policy implications.</title><pubDate>Mon, 04 Nov 2019 02:27:02 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191129</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191129</guid><description><![CDATA[<p>ntis_number: PB91-176248</p><p>page_range: 167-170</p><p>primary_author: Garrison Jr, Louis P</p><p>title: Medicaid, the uninsured, and national health spending: federal policy implications.</p><p>volume: Supp.</p><p>year_period: 1990 Supp.</p>]]></description></item><item><title>A comparison of Medicaid and non-Medicaid obstetrical care in California.</title><pubDate>Mon, 04 Nov 2019 02:27:02 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191165</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191165</guid><description><![CDATA[<p>abstract: The use of prenatal care and rates of low birth weight were examined among four groups of women who delivered in California in October 1983. Medicaid paid for the deliveries of two groups, and two groups were not so covered. The analyses suggest that longer Medicaid enrollment improved the use of prenatal care. The association between prenatal care and birth weight was less clear. For women under Medicaid, measures of infant and maternal morbidity, hospital characteristics, and Medicaid eligibility were all statistically related to charges, payments, and length of stay for the delivery hospitalization.</p><p>authors: Herz, Elicia J; Hirsch, Marilyn B; Wang, Ruey H</p><p>issue_mesh: Adolescence : Adult : California : Comparative Study : Eligibility Determination : Ethnic Groups/statistics &#x26; numerical data : Female : Human : Infant, Low Birth Weight : Infant, Newborn : Insurance, Health/statistics &#x26; numerical data : Medicaid/statistics &#x26; numerical data : Multivariate Analysis : Obstetrics/economics : Poverty Areas : Pregnancy : Pregnancy Outcome/economics : Prenatal Care/economics : Support, U.S. Gov't, Non-P.H.S. : United States</p><p>issue_number: 4</p><p>ntis_number: PB2001-105731</p><p>page_range: 1-16</p><p>primary_author: Howell, Embry M</p><p>title: A comparison of Medicaid and non-Medicaid obstetrical care in California.</p><p>volume: 12</p><p>year_period: 1991 Summer</p>]]></description></item><item><title>Medicaid: a view from the front lines.</title><pubDate>Mon, 04 Nov 2019 02:27:02 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191115</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191115</guid><description><![CDATA[<p>ntis_number: PB91-176248</p><p>page_range: 9-14</p><p>primary_author: Clarke, Gary J</p><p>title: Medicaid: a view from the front lines.</p><p>volume: Supp.</p><p>year_period: 1990 Supp.</p>]]></description></item><item><title>Business, households, and governments: health care costs, 1990.</title><pubDate>Mon, 04 Nov 2019 02:27:02 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191201</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191201</guid><description><![CDATA[<p>abstract: This annual article presents information on health care costs by business, households, and government. Households funded 35 percent of expenditures in 1990, government 33 percent, and business, 29 percent. During the last decade, health care costs continued to grow at annual rates of 8 to 16 percent. Burden measures show that rapidly rising costs faced by each sponsor sector are exceeding increases in each sector's ability to fund them. Increased burden is particularly acute for business. The authors discuss the problems these rising costs pose for business, particularly small business, and some of the strategies businesses employ to constrain this cost growth.</p><p>authors: Cowan, Cathy A</p><p>issue_mesh: Commerce/economics : Employer Health Costs/statistics &#x26; numerical data : Financing, Government/statistics &#x26; numerical data : Financing, Personal/statistics &#x26; numerical data : Health Care Costs/statistics &#x26; numerical data : Health Expenditures/statistics &#x26; numerical data/trends : Insurance, Health/statistics &#x26; numerical data : Private Sector/economics : Public Sector/economics : United States</p><p>issue_number: 2</p><p>ntis_number: PB92-167279</p><p>page_range: 83-93</p><p>primary_author: Levit, Katharine R</p><p>title: Business, households, and governments: health care costs, 1990.</p><p>volume: 13</p><p>year_period: 1991 Winter</p>]]></description></item><item><title>Modeling the costs of case management in long-term care.</title><pubDate>Mon, 04 Nov 2019 02:27:02 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191187</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191187</guid><description><![CDATA[<p>abstract: A conceptual approach to developing models for analyzing cost is applied to case management in long-term care. This conceptual approach uses four dimensions to classify case management programs. The application results in identifying five case management cost models. Empirical measures of case management costs and a set of determinants of the within-model variation in these costs are suggested for each model. This article discusses several policy relevant hypotheses that could be addressed by the empirical implementation of these cost models.</p><p>authors: Kane, Rosalie A; Moscovice, Ira S; Penrod, Joan D; Rich, Eugene C</p><p>issue_mesh: Models, Econometric : Capitation Fee : Fees, Medical : Health Care Costs/statistics &#x26; numerical data : Long-Term Care/economics : Medicaid/organization &#x26; administration : Models, Theoretical : Patient Care Planning/economics/organization &#x26; administration : Pilot Projects : Reimbursement Mechanisms : Support, U.S. Gov't, Non-P.H.S. : United States</p><p>issue_number: 1</p><p>ntis_number: PB92-128255</p><p>page_range: 73-81</p><p>primary_author: Davidson, Gestur B</p><p>title: Modeling the costs of case management in long-term care.</p><p>volume: 13</p><p>year_period: 1991 Fall</p>]]></description></item><item><title>Health maintenance organization environments in the 1980s and beyond.</title><pubDate>Mon, 04 Nov 2019 02:27:02 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191139</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191139</guid><description><![CDATA[<p>abstract: Throughout the past decade, health maintenance organizations (HMOs) were buffeted by dramatic regulatory and competitive changes. In this article, literature of the 1980s is reviewed to update our knowledge on the HMO industry and to suggest future research. The influence of intensified competition on these organizations and the determinants of market entry, expansion, and exit are examined. These organizations are now beginning to require copayments and deductibles and to offer point-of-service choice, while indemnity plans are developing sophisticated utilization management techniques. Given these significant structural changes, past distinctions among HMO, preferred provider organization and fee-for-service medicine must be replaced with a distinction between degree of provider choice and level of benefits.</p><p>authors: Luft, Harold S</p><p>issue_mesh: Economic Competition : Health Maintenance Organizations/organization &#x26; administration : Health Services Research : Medicaid/organization &#x26; administration : Medicare/organization &#x26; administration : Risk : Support, U.S. Gov't, Non-P.H.S. : United States</p><p>issue_number: 1</p><p>ntis_number: PB91-176255</p><p>page_range: 81-90</p><p>primary_author: Morrison, Ellen M</p><p>title: Health maintenance organization environments in the 1980s and beyond.</p><p>volume: 12</p><p>year_period: 1990 Fall</p>]]></description></item><item><title>Physician customary charges and Medicare payment experience: study findings [published erratum appears in Health Care Finance Rev 1992 Spring;13(3):preceding table of contents]</title><pubDate>Mon, 04 Nov 2019 02:27:01 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191199</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191199</guid><description><![CDATA[<p>abstract: Customary charges have had significant impacts in determining reasonable prices under the historic Medicare physician payment system. This article contains new, comprehensive information on customary charges as well as data aggregated at the physician level. These baseline data have some important policy implications, such as the study findings, that indicate that the Medicare fee schedule is likely to have significant impacts on individual physician practices. The study is based on data for medical, surgical, and consultation services for nine States.</p><p>authors: Harden, Stephen D</p><p>issue_mesh: Reimbursement Mechanisms : Fee Schedules : Fees, Medical/statistics &#x26; numerical data : Medicare Assignment : Medicare Part B/economics/organization &#x26; administration/statistics &#x26; numerical data : Office Visits/economics : Pilot Projects : Private Practice/economics : Rate Setting and Review/methods : Support, U.S. Gov't, Non-P.H.S. : United States</p><p>issue_number: 2</p><p>ntis_number: PB92-167279</p><p>page_range: 57-73</p><p>primary_author: Kowalczyk, George I</p><p>title: Physician customary charges and Medicare payment experience: study findings [published erratum appears in Health Care Finance Rev 1992 Spring;13(3):preceding table of contents]</p><p>volume: 13</p><p>year_period: 1991 Winter</p>]]></description></item><item><title>Financial performance in the social health maintenance organization, 1985-88.</title><pubDate>Mon, 04 Nov 2019 02:27:01 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191132</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191132</guid><description><![CDATA[<p>abstract: Since early 1985, four social health maintenance organizations have delivered integrated health and long-term care services to Medicare beneficiaries under congressionally mandated waivers that included shared public-program risk for losses. Three of four sites had substantial losses in the first 3 years, primarily because of slow enrollment and resultant high marketing and administrative costs. After assuming full risk, two of the three showed surpluses in 1988. Service and management costs for expanded long-term care were similar across sites and were affordable within the framework of Medicare and Medicaid reimbursement and private premiums.</p><p>authors: Kistner, Marlin; Malone, Joelyn; O'Bar, Tim; Ripley, Jeanne M; Sandhaus, Martin</p><p>issue_mesh: Accounts Payable and Receivable : Aged : Financial Management/trends : Health Maintenance Organizations/economics : Hospitalization : Human : Income/statistics &#x26; numerical data : Long-Term Care/economics : Medicare/organization &#x26; administration : Pilot Projects : Research Design : United States</p><p>issue_number: 1</p><p>ntis_number: PB91-176255</p><p>page_range: 9-18</p><p>primary_author: Leutz, Walter</p><p>title: Financial performance in the social health maintenance organization, 1985-88.</p><p>volume: 12</p><p>year_period: 1990 Fall</p>]]></description></item><item><title>Review effect on cost reports: impact smaller than anticipated.</title><pubDate>Mon, 04 Nov 2019 02:27:01 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191155</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191155</guid><description><![CDATA[<p>abstract: Hospitals seeking Medicare payment are required to submit Medicare Cost Reports to their respective fiscal intermediaries, who in turn are required to desk review and sometimes audit the reports. The reviewed or audited report is considered more reliable than the originally submitted report and provides the basis for final Medicare payment. This study quantifies the impact of the review process, finding that, for the most part, the effect is quite small, usually less than 1 percent. Passthrough costs, however, were the exception to this rule. Capital and education passthrough costs, on a per discharge basis, were reduced about 6 percent.</p><p>authors: N/A</p><p>issue_mesh: Financial Audit : Financial Management, Hospital : Capital Expenditures : Costs and Cost Analysis/statistics &#x26; numerical data : Education, Medical/economics : Evaluation Studies : Medicare Part A/organization &#x26; administration : Models, Statistical : Prospective Payment System/statistics &#x26; numerical data : Regression Analysis : United States : United States Health Care Financing Administration</p><p>issue_number: 3</p><p>ntis_number: PB91-201384</p><p>page_range: 21-25</p><p>primary_author: Cowles, C McKeen</p><p>title: Review effect on cost reports: impact smaller than anticipated.</p><p>volume: 12</p><p>year_period: 1991 Spring</p>]]></description></item><item><title>Preventive health care for Medicaid children.</title><pubDate>Mon, 04 Nov 2019 02:27:01 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191122</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191122</guid><description><![CDATA[<p>ntis_number: PB91-176248</p><p>page_range: 89-96</p><p>primary_author: Yudkowsky, Beth K</p><p>title: Preventive health care for Medicaid children.</p><p>volume: Supp.</p><p>year_period: 1990 Supp.</p>]]></description></item><item><title>Containing U.S. health care costs: What bullet to bite?</title><pubDate>Mon, 04 Nov 2019 02:27:01 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191175</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191175</guid><description><![CDATA[<p>ntis_number: PB99-106478</p><p>page_range: 1-12</p><p>primary_author: Jencks, Stephen F</p><p>title: Containing U.S. health care costs: What bullet to bite?</p><p>volume: Supp.</p><p>year_period: 1991 Supp.</p>]]></description></item><item><title>Savings estimate for a Medicare insured group.</title><pubDate>Mon, 04 Nov 2019 02:27:01 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191167</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191167</guid><description><![CDATA[<p>abstract: Estimates of the savings potential of a managed-care program for a Medicare retiree population in Michigan under a hypothetical Medicare insured group (MIG) are presented in this article. In return for receiving an experience-rated capitation payment, a MIG would administer all Medicare and employer complementary benefits for its enrollees. A study of the financial and operational feasibility of implementing a MIG for retirees of a national corporation involving an analysis of 1986 claims data finds that selected managed-care initiatives implemented by a MIG would generate an annual savings of 3.8 percent of total (Medicare plus complementary) expenditures. Although savings are less than the 5 percent to be retained by Medicare, this finding illustrates the potential for savings from managed-care initiatives to Medicare generally and to MIGs elsewhere, where savings may be greater if constraints are less restrictive.</p><p>authors: Hoffman, Kevin; Holland, Stephen K; Lenhart, Gregory M; Pardo, Dennis P; Reilly, Helena L</p><p>issue_mesh: Aged : Capitation Fee : Cost Control/methods : Feasibility Studies : Health Expenditures/statistics &#x26; numerical data : Health Services/utilization : Human : Industry/economics : Managed Care Programs/economics : Medicare/organization &#x26; administration : Michigan : Retirement/economics : Support, U.S. Gov't, Non-P.H.S. : United States : United States Health Care Financing Administration</p><p>issue_number: 4</p><p>ntis_number: PB2001-105731</p><p>page_range: 39-48</p><p>primary_author: Birnbaum, Howard</p><p>title: Savings estimate for a Medicare insured group.</p><p>volume: 12</p><p>year_period: 1991 Summer</p>]]></description></item><item><title>Payment to health maintenance organizations and the geographic factor.</title><pubDate>Mon, 04 Nov 2019 02:27:01 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191133</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191133</guid><description><![CDATA[<p>abstract: The adjusted average per capita cost (AAPCC) payment system for Medicare risk-based plans uses a county level geographic adjustment factor to account for differences in beneficiary costs across areas. The implications of abandoning the county unit as the basis of the geographic area are examined and the merging of counties to match the geographic definition used in the prospective payment system are considered. Year-to-year variation in a county AAPCC is inversely associated with county population size and, based on year-to-year AAPCC variation, 86 percent of all counties are too small to be used for the geographic adjustment.</p><p>authors: Adamache, Killard W</p><p>issue_mesh: Capitation Fee : Aged : Catchment Area (Health)/economics : Costs and Cost Analysis/statistics &#x26; numerical data : Geography : Health Maintenance Organizations/economics : Human : Long-Term Care/economics : Medicare/economics : Rate Setting and Review/methods : Support, U.S. Gov't, Non-P.H.S. : United States</p><p>issue_number: 1</p><p>ntis_number: PB91-176255</p><p>page_range: 19-30</p><p>primary_author: Rossiter, Louis F</p><p>title: Payment to health maintenance organizations and the geographic factor.</p><p>volume: 12</p><p>year_period: 1990 Fall</p>]]></description></item><item><title>Transitional funding: changing Ontario's global budgeting system.</title><pubDate>Mon, 04 Nov 2019 02:27:01 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191209</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191209</guid><description><![CDATA[<p>abstract: In 1988, Ontario introduced transitional funding, a collaborative process between the Ministry of Health and the hospitals to modify Ontario's global budgeting system. The goals are to achieve greater equity; encourage hospital efficiency, and promote a shift from inpatient to outpatient services. To implement these goals, inpatient care is being measured in terms of case-mix groups, i.e., a classification system comparable to the diagnosis-related groups. However, since there is no patient level cost data, cost weights are being derived from patient-level data from New York State. Transitional funding draws attention to both positive and negative aspects of global budgeting.</p><p>authors: Jacobs, Philip; Markel, Frank</p><p>issue_mesh: Budgets/organization &#x26; administration : Diagnosis-Related Groups/economics : Financial Management, Hospital/legislation &#x26; jurisprudence : Financing, Government/methods : Insurance, Hospitalization/economics : Interinstitutional Relations : Life Support Care/economics : National Health Programs/economics : Ontario : Organizational Innovation : Support, Non-U.S. Gov't</p><p>issue_number: 3</p><p>ntis_number: PB2001-105738</p><p>page_range: 77-84</p><p>primary_author: Lave, Judith R</p><p>title: Transitional funding: changing Ontario's global budgeting system.</p><p>volume: 13</p><p>year_period: 1992 Spring</p>]]></description></item><item><title>Medicaid mysteries: transitional benefits, Medicaid coverage, and welfare exits.</title><pubDate>Mon, 04 Nov 2019 02:27:01 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191125</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191125</guid><description><![CDATA[<p>ntis_number: PB91-176248</p><p>page_range: 119-131</p><p>primary_author: Ellwood, David T</p><p>title: Medicaid mysteries: transitional benefits, Medicaid coverage, and welfare exits.</p><p>volume: Supp.</p><p>year_period: 1990 Supp.</p>]]></description></item><item><title>Giving physicians incentives to contain costs under Medicaid.</title><pubDate>Mon, 04 Nov 2019 02:27:01 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191149</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191149</guid><description><![CDATA[<p>abstract: In this article, the risk arrangements in Medicaid programs that put physicians at risk are summarized. These programs--partial capitation and health insuring organizations--pay physicians a capitation amount to cover some or all physician services. Physicians also receive part of the savings from reduced hospitalization. Most of these programs have successfully lowered Medicaid costs. They could serve as models for other Medicaid programs, State-level programs to cover people ineligible for Medicaid, and programs abroad, such as in the United Kingdom.</p><p>authors: N/A</p><p>issue_mesh: Reimbursement, Incentive : Capitation Fee : Cost Control/methods : Medicaid/organization &#x26; administration : Patient Care Planning/economics : Physician's Practice Patterns/economics : Primary Health Care : Risk : Support, Non-U.S. Gov't : Support, U.S. Gov't, Non-P.H.S. : United States</p><p>issue_number: 2</p><p>ntis_number: PB91-176263</p><p>page_range: 103-112</p><p>primary_author: Welch, W Pete</p><p>title: Giving physicians incentives to contain costs under Medicaid.</p><p>volume: 12</p><p>year_period: 1990 Winter</p>]]></description></item><item><title>Medicare expenditures for physician and supplier services, 1970-88.</title><pubDate>Mon, 04 Nov 2019 02:27:01 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191163</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191163</guid><description><![CDATA[<p>abstract: The trend data in this article focus on Medicare expenditures and allowed charges for physician and supplier services rendered during the period from 1970 through 1988. A brief overview is presented on the provisions of the new Medicare physician payment system mandated by Congress and scheduled to be phased in starting January 1, 1992. The data provide one of the baselines that could be used for measuring and evaluating the impact of the new Medicare payment system for physician services.</p><p>authors: Keene, Roger E; Latta, Viola B</p><p>issue_mesh: Abstracting and Indexing : Fee Schedules/legislation &#x26; jurisprudence : Fees, Medical : Health Expenditures/trends : Medicare Assignment/statistics &#x26; numerical data : Medicare Part B/statistics &#x26; numerical data : Relative Value Scales : Specialties, Medical/economics : United States</p><p>issue_number: 3</p><p>ntis_number: PB91-201384</p><p>page_range: 109-120</p><p>primary_author: Helbing, Charles</p><p>title: Medicare expenditures for physician and supplier services, 1970-88.</p><p>volume: 12</p><p>year_period: 1991 Spring</p>]]></description></item><item><title>Comparison of Medicaid nursing home payment systems.</title><pubDate>Mon, 04 Nov 2019 02:27:01 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191189</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191189</guid><description><![CDATA[<p>abstract: This article summarizes the main findings of a study comparing three generic Medicaid nursing home payment systems: case-mix, facility-specific, and class-rate. The major comparative analyses examined patient-level case mix and quality, facility-level costs, Medicaid payment rates, and profitability. The study also analyzed case-mix payment systems in greater detail, emphasizing the earlier systems. The results suggest advantages and disadvantages for all system types and highlight important considerations for policyplanners, particularly in States considering case-mix systems. The article concludes with a discussion of issues important to further research on nursing home payment.</p><p>authors: N/A</p><p>issue_mesh: Activities of Daily Living : Comparative Study : Data Collection : Diagnosis-Related Groups/statistics &#x26; numerical data : Health Care Costs/statistics &#x26; numerical data : Income/statistics &#x26; numerical data : Long-Term Care/classification : Medicaid/organization &#x26; administration : Nursing Homes/economics : Quality of Health Care : Rate Setting and Review/methods : Reimbursement Mechanisms/economics/statistics &#x26; numerical data : Support, U.S. Gov't, Non-P.H.S. : United States</p><p>issue_number: 1</p><p>ntis_number: PB92-128255</p><p>page_range: 93-109</p><p>primary_author: Schlenker, Robert E</p><p>title: Comparison of Medicaid nursing home payment systems.</p><p>volume: 13</p><p>year_period: 1991 Fall</p>]]></description></item><item><title>Measuring hospital input price increases: the rebased hospital market basket.</title><pubDate>Mon, 04 Nov 2019 02:27:01 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191153</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191153</guid><description><![CDATA[<p>abstract: The input prices indexes used in part to set payment rates for Medicare inpatient hospital services in both prospective payment system (PPS) and PPS-excluded hospitals were rebased from 1982 to 1987 beginning with payments for fiscal year 1991. In this article, the issues and evidence used to determine the composition of the revised hospital input price indexes are discussed. One issue is the need for a separate market basket for PPS-excluded hospitals. Also, the payment implications of using hospital-industry versus economywide measures of wage rates as price proxies for the growth in hospital wage rates are addressed.</p><p>authors: Arnett 3d, Ross H; Brown, Aaron P; Chulis, George S; Lemieux, Jeffrey A; Maple, Brenda T; Singer, Naphtale; Skellan, David</p><p>issue_mesh: Prospective Payment System : Abstracting and Indexing : Cost Allocation/trends : Data Collection : Economics, Hospital/trends : Health Expenditures/trends : Inflation, Economic/statistics &#x26; numerical data : Medicare Part A/economics : Nursing Staff, Hospital/economics : Personnel, Hospital/economics : Rate Setting and Review/methods : Salaries and Fringe Benefits/statistics &#x26; numerical data : United States</p><p>issue_number: 3</p><p>ntis_number: PB91-201384</p><p>page_range: 1-14</p><p>primary_author: Freeland, Mark S</p><p>title: Measuring hospital input price increases: the rebased hospital market basket.</p><p>volume: 12</p><p>year_period: 1991 Spring</p>]]></description></item><item><title>Economic consequences for Medicaid of human immunodeficiency virus infection.</title><pubDate>Mon, 04 Nov 2019 02:27:01 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191123</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191123</guid><description><![CDATA[<p>ntis_number: PB91-176248</p><p>page_range: 97-108</p><p>primary_author: Baily, Mary A</p><p>title: Economic consequences for Medicaid of human immunodeficiency virus infection.</p><p>volume: Supp.</p><p>year_period: 1990 Supp.</p>]]></description></item><item><title>Patterns of outpatient prescription drug use among Pennsylvania elderly.</title><pubDate>Mon, 04 Nov 2019 02:27:01 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191159</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191159</guid><description><![CDATA[<p>abstract: The Pennsylvania Pharmaceutical Assistance Contract for the Elderly (PACE) provides outpatient prescription drug coverage for nearly one-half million State residents 65 years of age or over with income under $15,000 per year. A description of the PACE program is provided herein, along with data and multivariate results relating to the demographic characteristics of PACE beneficiaries, duration of enrollments, drug utilization and expenditure rates, average prices for covered prescriptions, and drug expense distributions.</p><p>authors: Ahern, Frank; Johnson, Albert; Rabatin, Vincent</p><p>issue_mesh: Aged : Drug Utilization/statistics &#x26; numerical data : Female : Health Expenditures/statistics &#x26; numerical data : Human : Insurance, Pharmaceutical Services/utilization : Male : Outpatients/statistics &#x26; numerical data : Pennsylvania : Prescriptions, Drug/economics : Socioeconomic Factors : State Health Plans/economics : Support, Non-U.S. Gov't : Support, U.S. Gov't, Non-P.H.S. : United States</p><p>issue_number: 3</p><p>ntis_number: PB91-201384</p><p>page_range: 61-72</p><p>primary_author: Stuart, Bruce</p><p>title: Patterns of outpatient prescription drug use among Pennsylvania elderly.</p><p>volume: 12</p><p>year_period: 1991 Spring</p>]]></description></item><item><title>Medicare-covered skilled nursing facility services, 1967-88.</title><pubDate>Mon, 04 Nov 2019 02:27:01 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191162</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191162</guid><description><![CDATA[<p>abstract: The skilled nursing facility benefit under Medicare has been difficult to administer because its intent has been subject to misinterpretation. This article describes the series of legislative and administrative actions taken to align the benefit's use with its intent. Data are presented to show the changes in utilization and program expenditures in response to the actions taken. The 1988 clarifications to the level-of-care requirements seem to have resulted in an increased level of use of skilled nursing facility services.</p><p>authors: N/A</p><p>issue_mesh: Aged : Eligibility Determination/legislation &#x26; jurisprudence : Human : Inpatients/statistics &#x26; numerical data : Medicare/organization &#x26; administration : Reimbursement Mechanisms : Skilled Nursing Facilities/economics/utilization : United States</p><p>issue_number: 3</p><p>ntis_number: PB91-201384</p><p>page_range: 103-108</p><p>primary_author: Silverman, Herbert A</p><p>title: Medicare-covered skilled nursing facility services, 1967-88.</p><p>volume: 12</p><p>year_period: 1991 Spring</p>]]></description></item><item><title>Access to hospital care for California and Michigan Medicaid recipients.</title><pubDate>Mon, 04 Nov 2019 02:27:01 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191172</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191172</guid><description><![CDATA[<p>abstract: This article is a comparison of the characteristics of hospitals serving the general population and Medicaid recipients in California and Michigan, using data from Medicaid uniform claims files and the American Hospital Association Annual Survey for 1984. A greater concentration of discharges in a small number of "high Medicaid volume" urban and rural hospitals in each State was observed for Medicaid recipients compared with the general population. In addition, discharge data suggest that Supplemental Security Income crossovers (individuals covered by both Medicaid and Medicare) and other recipients (mostly children not enrolled in the Aid to Families with Dependent Children program) receive inpatient care in different hospitals from the general population as well as from other Medicaid eligibility groups. Medicaid cost-containment policies and differential access to hospital care are discussed.</p><p>authors: Dodds, Suzanne; Herz, Elicia J; Ruther, Martin M</p><p>issue_mesh: California : Comparative Study : Health Services Accessibility/economics : Hospital Bed Capacity : Hospitals, Rural/utilization : Hospitals, Teaching/utilization : Hospitals, Urban/utilization : Medicaid/statistics &#x26; numerical data : Michigan : Ownership/statistics &#x26; numerical data : Patient Discharge/statistics &#x26; numerical data : Support, U.S. Gov't, Non-P.H.S. : United States</p><p>issue_number: 4</p><p>ntis_number: PB2001-105731</p><p>page_range: 99-104</p><p>primary_author: Andrews, Roxanne M</p><p>title: Access to hospital care for California and Michigan Medicaid recipients.</p><p>volume: 12</p><p>year_period: 1991 Summer</p>]]></description></item><item><title>Insights on the dynamics of Medicaid: Introduction</title><pubDate>Mon, 04 Nov 2019 02:27:01 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191112</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191112</guid><description><![CDATA[<p>ntis_number: PB91-176248</p><p>page_range: 1</p><p>primary_author: Kenesson, Mary S</p><p>title: Insights on the dynamics of Medicaid: Introduction</p><p>volume: Supp.</p><p>year_period: 1990 Supp.</p>]]></description></item><item><title>Procedure codes: potential modifiers of diagnosis-related groups.</title><pubDate>Mon, 04 Nov 2019 02:27:01 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191135</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191135</guid><description><![CDATA[<p>abstract: Proposals to make complexity-of-illness adjustments to the diagnosis-related group system have relied on secondary diagnosis codes and additional clinical information obtained from the hospital record. Another potential mechanism for modifying diagnosis-related groups involves the use of non-operating room procedure codes. The use of these codes has the advantage of reliably identifying costly subgroups of patients and thus the potential to provide for fairer compensation to hospitals caring for the sickest patients. There are a number of disadvantages, however, and therefore the criteria with which to evaluate procedures as potential modifiers are suggested.</p><p>authors: Fetter, Robert B; Lichtenstein, Jeffrey</p><p>issue_mesh: Comorbidity : Severity of Illness Index : Abstracting and Indexing/methods : Cardiovascular Diseases/economics : Diagnosis-Related Groups/classification : Fees and Charges/statistics &#x26; numerical data : Hospitalization/economics : Human : Length of Stay/statistics &#x26; numerical data : Prospective Payment System : Research : Respiration Disorders/economics : Support, U.S. Gov't, Non-P.H.S. : United States</p><p>issue_number: 1</p><p>ntis_number: PB91-176255</p><p>page_range: 39-46</p><p>primary_author: Hughes, John S</p><p>title: Procedure codes: potential modifiers of diagnosis-related groups.</p><p>volume: 12</p><p>year_period: 1990 Fall</p>]]></description></item><item><title>Utilization management as a cost-containment strategy.</title><pubDate>Mon, 04 Nov 2019 02:27:01 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191182</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191182</guid><description><![CDATA[<p>ntis_number: PB99-106478</p><p>page_range: 87-93</p><p>primary_author: Bailit, Howard L</p><p>title: Utilization management as a cost-containment strategy.</p><p>volume: Supp.</p><p>year_period: 1991 Supp.</p>]]></description></item><item><title>Achieving cost control in the hospital outpatient department.</title><pubDate>Mon, 04 Nov 2019 02:27:00 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191183</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191183</guid><description><![CDATA[<p>ntis_number: PB99-106478</p><p>page_range: 95-106</p><p>primary_author: Sulvetta, Margaret B</p><p>title: Achieving cost control in the hospital outpatient department.</p><p>volume: Supp.</p><p>year_period: 1991 Supp.</p>]]></description></item><item><title>Why do some caregivers of disabled and frail elderly quit?</title><pubDate>Mon, 04 Nov 2019 02:27:00 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191197</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191197</guid><description><![CDATA[<p>abstract: In this study, the authors examine the extent to which the characteristics of caregivers or recipients determine the probability that caregivers stop being caregivers. We find that caregivers' characteristics such as working outside their homes, raising children, or having their own health problems do not increase this probability. Nor does the emotional distress of caregiving increase the probability of quitting. However, caregivers are more likely to quit when recipients have six to seven disabilities in activities of daily living and need help on demand around the clock. This study also determines that assistive equipment, home modifications, and attendance at senior centers do not reduce the probability that caregivers quit.</p><p>authors: Muller, Charlotte F</p><p>issue_mesh: Activities of Daily Living : Aged : Caregivers/psychology/supply &#x26; distribution/statistics &#x26; numerical data : Child : Child Rearing : Decision Making : Disabled Persons/statistics &#x26; numerical data : Employment/statistics &#x26; numerical data : Frail Elderly/statistics &#x26; numerical data : Health Status : Home Nursing/manpower/statistics &#x26; numerical data : Human : Questionnaires : Regression Analysis : Support, U.S. Gov't, P.H.S. : United States</p><p>issue_number: 2</p><p>ntis_number: PB92-167279</p><p>page_range: 41-47</p><p>primary_author: Boaz, Rachel F</p><p>title: Why do some caregivers of disabled and frail elderly quit?</p><p>volume: 13</p><p>year_period: 1991 Winter</p>]]></description></item><item><title>A longitudinal comparison of charge-based weights with cost-based weights.</title><pubDate>Mon, 04 Nov 2019 02:27:00 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191207</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191207</guid><description><![CDATA[<p>abstract: The diagnosis-related group weights that determine prices for Medicare hospital stays are recalibrated annually using charge data. Using data from fiscal years 1985 through 1987, the authors show that differences between these charge-based weights and cost-based weights are increasing only slightly. Charge-based weights are available in a more timely manner and, based on temporal changes in the weights, we show that this is an important consideration. Charge-based weights provide higher payments than cost-based weights to hospitals with higher case-mix indexes, but have little effect on hospitals with low cost-to-charge ratios, high capital costs, or high teaching costs.</p><p>authors: Farley, Donna O</p><p>issue_mesh: Comparative Study : Costs and Cost Analysis/statistics &#x26; numerical data : Diagnosis-Related Groups/classification/economics : Economics, Hospital/statistics &#x26; numerical data : Fees and Charges/statistics &#x26; numerical data : Health Resources/classification/economics : Health Services Research : Longitudinal Studies : Medicare/economics : Prospective Payment System/economics : Reference Values : Support, Non-U.S. Gov't : Support, U.S. Gov't, Non-P.H.S. : United States</p><p>issue_number: 3</p><p>ntis_number: PB2001-105738</p><p>page_range: 53-63</p><p>primary_author: Carter, Grace M</p><p>title: A longitudinal comparison of charge-based weights with cost-based weights.</p><p>volume: 13</p><p>year_period: 1992 Spring</p>]]></description></item><item><title>Medicare short-stay hospital services by diagnosis-related groups.</title><pubDate>Mon, 04 Nov 2019 02:27:00 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191173</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191173</guid><description><![CDATA[<p>abstract: The 1983 amendments to the Social Security Act (Public Law 98-21) provided for a prospective payment system (PPS), effective October 1, 1983, for most short-stay hospitals certified to provide inpatient services to Medicare beneficiaries. A brief description of the assignment process for diagnosis-related groups (DRGs) is presented, because assigning a DRG code to a short-stay hospital discharge record is tantamount to the Medicare prospective payment to the hospital, subject to certain statutory adjustments. Shifts in the distribution of the discharges and average length of stay among the DRGs since 1983 reflect the adaptation of hospitals to the incentives embedded in PPS and the ongoing refinements in the methods of assigning DRGs to discharges from short-stay hospitals. Interpretation of the shifts is based on a consideration of the significant refinements in the medical coding system, the technological and scientific advances in the practice of medicine, the effect of shifting patient treatment to alternative sites, policy or legislative changes affecting Medicare coverage, and the annual recalibration of the DRG weights.</p><p>authors: Helbing, Charles</p><p>issue_mesh: Data Collection : Diagnosis-Related Groups/statistics &#x26; numerical data : Hospitals/utilization : Length of Stay/statistics &#x26; numerical data : Medicare Part A/statistics &#x26; numerical data : Patient Discharge/statistics &#x26; numerical data : Prospective Payment System/statistics &#x26; numerical data : United States</p><p>issue_number: 4</p><p>ntis_number: PB2001-105731</p><p>page_range: 105-140</p><p>primary_author: Latta, Viola B</p><p>title: Medicare short-stay hospital services by diagnosis-related groups.</p><p>volume: 12</p><p>year_period: 1991 Summer</p>]]></description></item><item><title>National health expenditures, 1990.</title><pubDate>Mon, 04 Nov 2019 02:27:00 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191185</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191185</guid><description><![CDATA[<p>abstract: During 1990, health expenditures as a share of gross national product rose to 12.2 percent, up from 11.6 percent in 1989. This dramatic increase is the second largest increase in the past three decades. The national health expenditure estimates presented in this article document rapidly rising health care costs and provide a context for understanding the health care financing crisis facing the Nation today. The 1990 national health expenditures incorporate the most recently available data. They differ from historical estimates presented in the preceding article. The length of time and complicated process of producing projections required use of 1989 national health expenditures--data available prior to the completion of the 1990 estimates presented here.</p><p>authors: Cowan, Cathy A; Lazenby, Helen C; Letsch, Suzanne W</p><p>issue_mesh: Actuarial Analysis : Data Collection : Health Expenditures/statistics &#x26; numerical data : Home Care Services/economics : Hospitalization/economics : Insurance, Health/statistics &#x26; numerical data : Medicaid/statistics &#x26; numerical data : Medicare/statistics &#x26; numerical data : Nursing Homes/economics : Personal Health Services/economics : Physicians/economics : United States</p><p>issue_number: 1</p><p>ntis_number: PB92-128255</p><p>page_range: 29-54</p><p>primary_author: Levit, Katharine R</p><p>title: National health expenditures, 1990.</p><p>volume: 13</p><p>year_period: 1991 Fall</p>]]></description></item><item><title>Changes in Medicare skilled nursing facility benefit admissions.</title><pubDate>Mon, 04 Nov 2019 02:27:00 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191143</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191143</guid><description><![CDATA[<p>abstract: In this article, the changes in Medicare skilled nursing facility (SNF) benefit admissions from 1983 through 1985 are examined and factors that influence changes in access since the implementation of Medicare's prospective payment system are analyzed. During this period, use of the SNF benefit increased nationally by 21 percent. Multivariate analysis is used to determine factors associated with changes in admissions. Changes in SNF benefit admissions were found to be negatively associated with changes in area hospitals' lengths of stay and changes in hospitals' discharges. Medicaid reimbursement policies were also shown to affect changes in utilization.</p><p>authors: N/A</p><p>issue_mesh: Bed Conversion : Medicare/statistics &#x26; numerical data : Multivariate Analysis : Patient Discharge/statistics &#x26; numerical data : Prospective Payment System/statistics &#x26; numerical data : Reimbursement Mechanisms : Skilled Nursing Facilities/supply &#x26; distribution/utilization : Support, U.S. Gov't, P.H.S. : United States</p><p>issue_number: 2</p><p>ntis_number: PB91-176263</p><p>page_range: 27-35</p><p>primary_author: Dubay, Lisa C</p><p>title: Changes in Medicare skilled nursing facility benefit admissions.</p><p>volume: 12</p><p>year_period: 1990 Winter</p>]]></description></item><item><title>Health care cost containment in the Federal Republic of Germany.</title><pubDate>Mon, 04 Nov 2019 02:27:00 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191161</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191161</guid><description><![CDATA[<p>abstract: Since 1977, cost containment has been an integral part of health policy in the Federal Republic of Germany. The common goal of the cost-containment acts was to bring the growth of health care expenditures in line with growth of wages and salaries of sickness fund members. The Health Care Reform Act of 1989 is the most recent manifestation of this policy. The main features of the numerous cost-containment acts are described in this article, and the effects of cost containment on supply and demand are analyzed.</p><p>authors: N/A</p><p>issue_mesh: Ambulatory Care/economics : Cost Control/legislation &#x26; jurisprudence : Delivery of Health Care/economics : Dental Care/economics : Economics, Hospital : Germany, West : Health Expenditures/trends : Health Services Needs and Demand : Insurance, Health/legislation &#x26; jurisprudence : Models, Theoretical : National Health Programs/organization &#x26; administration : Pharmaceutical Services/economics : Support, U.S. Gov't, Non-P.H.S.</p><p>issue_number: 3</p><p>ntis_number: PB91-201384</p><p>page_range: 87-101</p><p>primary_author: Schneider, Markus</p><p>title: Health care cost containment in the Federal Republic of Germany.</p><p>volume: 12</p><p>year_period: 1991 Spring</p>]]></description></item><item><title>Improving state Medicaid programs for pregnant women and children.</title><pubDate>Mon, 04 Nov 2019 02:27:00 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191121</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191121</guid><description><![CDATA[<p>ntis_number: PB91-176248</p><p>page_range: 75-87</p><p>primary_author: Hill, Ian T</p><p>title: Improving state Medicaid programs for pregnant women and children.</p><p>volume: Supp.</p><p>year_period: 1990 Supp.</p>]]></description></item><item><title>Trends and patterns in place of death for Medicare enrollees.</title><pubDate>Mon, 04 Nov 2019 02:27:00 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191131</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191131</guid><description><![CDATA[<p>abstract: Two changes in the Medicare program in 1983 may have affected where aged persons die--the change from retrospective hospital reimbursement to the prospective payment system and passage of the Medicare hospice benefit. Patterns and trends in where people die--hospitals, other institutions such as nursing homes, decedents' homes, and other places--for persons 65 years of age or over from 1980 through 1986 are examined. The proportion of deaths in hospitals declined somewhat after implementation of prospective payment. The hospice benefit may have caused the shift among cancer patients away from hospital deaths toward deaths at home.</p><p>authors: Lubitz, James; McBean, A Marshall; Mentnech, Renee M; Russell, Delores</p><p>issue_mesh: Mortality : Aged : Cerebrovascular Disorders/mortality : Data Collection : Demography : Heart Diseases/mortality : Hospitals/statistics &#x26; numerical data : Human : Medicare/statistics &#x26; numerical data : National Center for Health Statistics (U.S.) : Neoplasms/mortality : Nursing Homes/statistics &#x26; numerical data : United States/epidemiology</p><p>issue_number: 1</p><p>ntis_number: PB91-176255</p><p>page_range: 1-8</p><p>primary_author: McMillan, Alma</p><p>title: Trends and patterns in place of death for Medicare enrollees.</p><p>volume: 12</p><p>year_period: 1990 Fall</p>]]></description></item><item><title>Does one national prospective payment system market basket make sense?</title><pubDate>Mon, 04 Nov 2019 02:27:00 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191017</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191017</guid><description><![CDATA[<p>abstract: For the first 4 years of Medicare's prospective payment system (PPS), one national market basket of cost weights and price proxies has been used to update payment rates. Previous evidence for a single rate is reviewed, and more recent data are presented that show definite regional differences in input price inflation, resulting in systematic gains or losses for some regions. However, as long as the Health Care Financing Administration continues to periodically update its hospital wage index, the net impact on hospitals is minor. Nevertheless, large differences in PPS-excluded hospital cost shares indicate the need for two sets of cost weights.</p><p>authors: N/A</p><p>issue_mesh: American Hospital Association : Catchment Area (Health)/economics : Comparative Study : Costs and Cost Analysis/statistics &#x26; numerical data : Economics, Hospital/statistics &#x26; numerical data : Medicare/statistics &#x26; numerical data : Models, Statistical : Prospective Payment System/methods : Salaries and Fringe Benefits/statistics &#x26; numerical data : Support, Non-U.S. Gov't : United States : United States Health Care Financing Administration</p><p>issue_number: 2</p><p>ntis_number: PB89-188486</p><p>page_range: 25-35</p><p>primary_author: Cromwell, Jerry L</p><p>title: Does one national prospective payment system market basket make sense?</p><p>volume: 10</p><p>year_period: 1988 Winter</p>]]></description></item><item><title>Inspection of care: findings from an innovative demonstration.</title><pubDate>Mon, 04 Nov 2019 02:27:00 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191084</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191084</guid><description><![CDATA[<p>abstract: In this article, information is presented concerning the efficacy of a sample-based approach to completing inspection of care reviews of Medicaid-supported nursing home residents. Massachusetts nursing homes were randomly assigned to full (the control group) or sample (the experimental group) review conditions. The primary research focus was to determine whether the proportion of facilities found to be deficient (based on quality of care and level of care criteria) in the experimental sample was comparable to the proportion in the control sample. The findings supported such a hypothesis: Deficient facilities appear to be equally identifiable using the random or full-sampling protocols, and the process can be completed with a considerable savings of surveyor time.</p><p>authors: Dreyer, Paul; Sherwood, Clarence C</p><p>issue_mesh: Certification : Comparative Study : Concurrent Review/methods : Data Collection : Evaluation Studies : Intermediate Care Facilities/standards : Massachusetts : Medicaid/standards : Nursing Homes/standards : Pilot Projects : Quality of Health Care/statistics &#x26; numerical data : Random Allocation : Sampling Studies : Skilled Nursing Facilities/standards : United States</p><p>issue_number: 2</p><p>ntis_number: PB90-204629</p><p>page_range: 57-63</p><p>primary_author: Morris, John N</p><p>title: Inspection of care: findings from an innovative demonstration.</p><p>volume: 11</p><p>year_period: 1989 Winter</p>]]></description></item><item><title>Private health insurance plans in 1977: coverage, enrollment, and financial experience.</title><pubDate>Mon, 04 Nov 2019 02:27:00 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191048</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191048</guid><description><![CDATA[<p>abstract: The private health insurance industry collected $47.1 billion in premiums in 1977 and returned $41.6 billion in benefits to their subscribers. Premiums rose 16.3 percent as a direct consequence of rapid claims growth in 1976. After operating expenses were deducted, the industry showed a small, $.4 billion underwriting loss. About 78 percent of the population were insured for hospital care, and about 76 percent for surgical services. Smaller percentages had coverage for other types of care. An estimated 61.8 percent of the aged bought private hospital insurance, and 47.1 percent bought surgical insurance, mostly to supplement Medicare benefits. About 12 percent of persons under age 65 had no protection against the cost of hospital care either through private insurance or a public program such as Medicare or Medicaid.</p><p>authors: Arnett 3d, Ross H</p><p>issue_mesh: Data Collection : Health Expenditures/trends : Insurance Benefits/trends : Insurance, Health/trends : Statistics : United States</p><p>issue_number: 2</p><p>ntis_number: PB81-112807</p><p>page_range: 3-22</p><p>primary_author: Carroll, Marjorie S</p><p>title: Private health insurance plans in 1977: coverage, enrollment, and financial experience.</p><p>volume: 1</p><p>year_period: 1979 Fall</p>]]></description></item><item><title>Alternatives for using multivariate regression to adjust prospective payment rates.</title><pubDate>Mon, 04 Nov 2019 02:27:00 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191092</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191092</guid><description><![CDATA[<p>abstract: Multivariate regression analysis has been used in structuring three of the adjustments to Medicare's prospective payment rates. Because the indirect-teaching adjustment, the disproportionate-share adjustment, and the adjustment for large cities are responsible for distributing approximately $3 billion in payments each year, the specification of regression models for these adjustments is of critical importance. In this article, the application of regression for adjusting Medicare's prospective rates is discussed, and the implications that differing specifications could have for these adjustments are demonstrated.</p><p>authors: N/A</p><p>issue_mesh: Multivariate Analysis : Regression Analysis : Hospitals, Rural/economics : Hospitals, Teaching/economics : Hospitals, Urban/economics : Medicare/organization &#x26; administration : Models, Statistical : Prospective Payment System/organization &#x26; administration : Rate Setting and Review/methods : Socioeconomic Factors : United States</p><p>issue_number: 3</p><p>ntis_number: PB90-258153</p><p>page_range: 31-41</p><p>primary_author: Sheingold, Steven H</p><p>title: Alternatives for using multivariate regression to adjust prospective payment rates.</p><p>volume: 11</p><p>year_period: 1990 Spring</p>]]></description></item><item><title>National health expenditures, 1988. Office of National Cost Estimates.</title><pubDate>Mon, 04 Nov 2019 02:27:00 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191101</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191101</guid><description><![CDATA[<p>abstract: Every year, analysts in the Health Care Financing Administration present figures on what our Nation spends for health. As the result of a comprehensive re-examination of the definitions, concepts, methods, and data sources used to prepare those figures, this year's report contains new estimates of national health expenditures for calendar years 1960 through 1988. Significant changes have been made to estimates of spending for professional services and to estimates of what consumers pay out of pocket for health care. In the first article, trends in use of and expenditure for various types of goods and services are discussed, as well as trends in the sources of funds used to finance health care. In a companion article, the benchmark process is described in more detail, as are the data sources and methods used to prepare annual estimates of health expenditures.</p><p>authors: Blank, Loius A; Brown, Aaron P; Cowan, Cathy A; Donham, Carolyn S; Freeland, Mark S; Lazenby, Helen C; Letsch, Suzanne W; Levit, Katharine R; Maple, Brenda T</p><p>issue_mesh: Economics, Hospital/statistics &#x26; numerical data : Economics, Medical/statistics &#x26; numerical data : Health Expenditures/statistics &#x26; numerical data : Medicaid/statistics &#x26; numerical data : Medicare/statistics &#x26; numerical data : United States : United States Health Care Financing Administration</p><p>issue_number: 4</p><p>ntis_number: PB91-105973</p><p>page_range: 1-41</p><p>primary_author: Arnett 3d, Ross H</p><p>title: National health expenditures, 1988. Office of National Cost Estimates.</p><p>volume: 11</p><p>year_period: 1990 Summer</p>]]></description></item><item><title>Health care indicators.</title><pubDate>Mon, 04 Nov 2019 02:27:00 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191152</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191152</guid><description><![CDATA[<p>abstract: Contained in this regular feature of the journal is a section on each of the following five topics: community hospital statistics; employment, hours, and earnings in the private health sector; health care prices; hospital skill mix changes: 1980s; and national economic indicators.</p><p>authors: Lemieux, Jeffrey A; Maple, Brenda T</p><p>issue_mesh: Actuarial Analysis : Economics, Hospital/statistics &#x26; numerical data : Economics/statistics &#x26; numerical data : Health Expenditures/statistics &#x26; numerical data : Hospitals, Community/statistics &#x26; numerical data : Prospective Payment System/statistics &#x26; numerical data : Salaries and Fringe Benefits/statistics &#x26; numerical data : United States</p><p>issue_number: 2</p><p>ntis_number: PB91-176263</p><p>page_range: 139-158</p><p>primary_author: Donham, Carolyn S</p><p>title: Health care indicators.</p><p>volume: 12</p><p>year_period: 1990 Winter</p>]]></description></item><item><title>Prospective payment for Medicare hospital capital: implications of the research.</title><pubDate>Mon, 04 Nov 2019 02:26:59 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191181</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191181</guid><description><![CDATA[<p>ntis_number: PB99-106478</p><p>page_range: 79-86</p><p>primary_author: Cotterill, Philip G</p><p>title: Prospective payment for Medicare hospital capital: implications of the research.</p><p>volume: Supp.</p><p>year_period: 1991 Supp.</p>]]></description></item><item><title>Potential for inpatient-outpatient substitution with diagnosis-related groups.</title><pubDate>Mon, 04 Nov 2019 02:26:59 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191037</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191037</guid><description><![CDATA[<p>abstract: Through analysis of data from the universal health insurance system in Manitoba, Canada, surgical diagnosis-related groups (DRG's) with the greatest potential for inpatient-outpatient substitution are identified. Candidates for both "inpatient shift" and "outpatient shift" are discussed. It is also suggested that determination of the procedure chiefly responsible for hospital admission complements approaches to improve the DRG classification system by measuring severity of illness. Thus, health care planners' efforts may be facilitated in establishing effective payment systems, though definitive guidelines are not provided.</p><p>authors: Freeman, Jean L</p><p>issue_mesh: Aged : Ambulatory Surgical Procedures/economics : Comparative Study : Diagnosis-Related Groups/economics : Hospitalization/economics : Human : Inpatients : Insurance, Health/utilization : Insurance, Surgical/utilization : Manitoba : Medicare : Outpatients : Prospective Payment System/economics : Support, Non-U.S. Gov't : Surgical Procedures, Operative/classification/economics : United States</p><p>issue_number: 4</p><p>ntis_number: PB89-232342</p><p>page_range: 31-38</p><p>primary_author: Roos, Noralou P</p><p>title: Potential for inpatient-outpatient substitution with diagnosis-related groups.</p><p>volume: 10</p><p>year_period: 1989 Summer</p>]]></description></item><item><title>Longlife insurance: a prototype for funding long-term care.</title><pubDate>Mon, 04 Nov 2019 02:26:59 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191019</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191019</guid><description><![CDATA[<p>abstract: Longlife insurance combines nursing home, home health, and deferred annuity benefits. It costs less than life care, allows the elderly to remain in their own homes, and protects assets. Adverse selection is limited because the plan is attractive to both frail and healthy elders. An analysis of 18,600 respondents in the Social Security Administration's New Beneficiary Survey indicates that 67 percent of all retirees could afford a typical longlife insurance plan. However, less than one-half of all females living alone, 24 percent of minorities, and 8 percent of the disabled could pay privately.</p><p>authors: N/A</p><p>issue_mesh: Retirement : Actuarial Analysis : Aged : Female : Financing, Personal/methods : Health Services for the Aged/economics : Human : Income : Insurance Selection Bias : Insurance, Life/economics : Insurance, Long-Term Care/methods : Interviews : Male : Medicaid/statistics &#x26; numerical data : United States</p><p>issue_number: 2</p><p>ntis_number: PB89-188486</p><p>page_range: 47-56</p><p>primary_author: Getzen, Thomas E</p><p>title: Longlife insurance: a prototype for funding long-term care.</p><p>volume: 10</p><p>year_period: 1988 Winter</p>]]></description></item><item><title>Medigap preferred provider organizations: issues, implications, and early experience.</title><pubDate>Mon, 04 Nov 2019 02:26:59 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191171</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191171</guid><description><![CDATA[<p>abstract: The Health Care Financing Administration is sponsoring the Medicare Physician Preferred Provider Organization (PPO) Demonstration to assess the feasibility and desirability of including a PPO option under Medicare. Two sites are currently operational. At one site, Blue Cross and Blue Shield of Arizona is offering a PPO linked with a medigap insurance plan. This "medigap PPO" and its initial experience are described, and a preliminary assessment of the viability and effectiveness of medigap PPOs nationally is provided. Impediments to the development and effectiveness of medigap PPOs are identified and possible government actions discussed.</p><p>authors: Quinn, Elizabeth; Sing, Merrile; Swearingen, Gary</p><p>issue_mesh: Aged : Arizona : Blue Cross : Blue Shield : Consumer Participation/economics : Evaluation Studies : Human : Insurance Benefits : Medicare/organization &#x26; administration : Motivation : Pilot Projects : Preferred Provider Organizations/organization &#x26; administration : Socioeconomic Factors : Support, U.S. Gov't, Non-P.H.S. : United States</p><p>issue_number: 4</p><p>ntis_number: PB2001-105731</p><p>page_range: 87-97</p><p>primary_author: Nelson, Lyle</p><p>title: Medigap preferred provider organizations: issues, implications, and early experience.</p><p>volume: 12</p><p>year_period: 1991 Summer</p>]]></description></item><item><title>Experience of a Medicaid nursing home entry cohort.</title><pubDate>Mon, 04 Nov 2019 02:26:59 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191039</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191039</guid><description><![CDATA[<p>abstract: Long-term care cost-containment policies have focused on reducing the numbers of persons entering nursing homes. To provide insight and background for such efforts, the authors studied the experience of Medicaid nursing home entry cohorts in three individual States. They found substantial interstate variation in rates of nursing home entry and subsequent patterns of discharge, suggesting the operation of fundamentally different policies for provision of Medicaid nursing home services. Analysis of the cost effectiveness and quality of care implications of these policies may provide guidance for future cost-containment efforts.</p><p>authors: Baugh, David K; Dodds, Suzanne; Federspiel, Charles F</p><p>issue_mesh: Aged : Aged, 80 and over : California : Chronic Disease : Comparative Study : Demography : Female : Human : Male : Medicaid/utilization : Michigan : New York : Nursing Homes/utilization : Patient Admission/statistics &#x26; numerical data : Patient Discharge/statistics &#x26; numerical data : Support, U.S. Gov't, Non-P.H.S. : United States</p><p>issue_number: 4</p><p>ntis_number: PB89-232342</p><p>page_range: 51-63</p><p>primary_author: Ray, Wayne A</p><p>title: Experience of a Medicaid nursing home entry cohort.</p><p>volume: 10</p><p>year_period: 1989 Summer</p>]]></description></item><item><title>The burden of health care costs: business, households, and governments.</title><pubDate>Mon, 04 Nov 2019 02:26:59 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191151</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191151</guid><description><![CDATA[<p>abstract: In this article, the authors recast health care costs into payer categories of business, households, and Federal and State-and-local governments which are more useful for policy analysis. The burden that these costs place upon the financial resources of each payer are examined for 1989 and for trends over time. For businesses, their share of health care costs continues to creep upward compared with other payers and relative to their own resources, despite many changes they are making in the provision of employer-sponsored health insurance to their employees.</p><p>authors: Cowan, Cathy A</p><p>issue_mesh: Actuarial Analysis : Commerce/economics/statistics &#x26; numerical data : Costs and Cost Analysis/statistics &#x26; numerical data : Financing, Personal/statistics &#x26; numerical data : Government : Health Expenditures/statistics &#x26; numerical data : Insurance, Health/statistics &#x26; numerical data : United States</p><p>issue_number: 2</p><p>ntis_number: PB91-176263</p><p>page_range: 127-137</p><p>primary_author: Levit, Katharine R</p><p>title: The burden of health care costs: business, households, and governments.</p><p>volume: 12</p><p>year_period: 1990 Winter</p>]]></description></item><item><title>Rural hospital wages.</title><pubDate>Mon, 04 Nov 2019 02:26:59 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191080</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191080</guid><description><![CDATA[<p>abstract: Average fiscal year 1982 wages from 2,302 rural American hospitals were used to test for a gradient descending from hospitals in counties adjacent to metropolitan areas to those not adjacent. Considerable variation in the ratios of adjacent to nonadjacent averages existed. No statistically significant difference was found, however. Of greater importance in explaining relative wages within States were occupational mix, mix of part-time and full-time workers, case mix, presence of medical residencies, and location in a high-rent county within the State. Medicare already adjusts payments for only two of these variables.</p><p>authors: N/A</p><p>issue_mesh: Catchment Area (Health)/economics : Data Collection : Demography : Hospitals : Hospitals, Rural/economics : Models, Statistical : Personnel, Hospital/economics : Professional Practice Location/economics : Regression Analysis : Salaries and Fringe Benefits/statistics &#x26; numerical data : Support, U.S. Gov't, P.H.S. : United States : United States Health Care Financing Administration</p><p>issue_number: 2</p><p>ntis_number: PB90-204629</p><p>page_range: 13-18</p><p>primary_author: Hendricks, Ann M</p><p>title: Rural hospital wages.</p><p>volume: 11</p><p>year_period: 1989 Winter</p>]]></description></item><item><title>Pricing Medicare's diagnosis-related groups: charges versus estimated costs.</title><pubDate>Mon, 04 Nov 2019 02:26:59 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191074</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191074</guid><description><![CDATA[<p>abstract: Hospital payments under Medicare's prospective payment system (PPS) are based on prices established for 474 diagnosis-related groups (DRG's). Previous analyses using 1981 data demonstrated that DRG prices based on charges alone were not that different from prices calculated from estimated costs. Data for 1986 were used in this study to show that the differences between the two sets of DRG prices are much larger than previously reported. If DRG prices were once again based on estimated costs instead of the current charge-based prices, payments would be significantly redistributed.</p><p>authors: N/A</p><p>issue_mesh: Costs and Cost Analysis : Fees and Charges : Prospective Payment System : Abstracting and Indexing : Comparative Study : Diagnosis-Related Groups/economics : Economics, Hospital/statistics &#x26; numerical data : Medicare/economics : United States</p><p>issue_number: 1</p><p>ntis_number: PB90-146705</p><p>page_range: 79-90</p><p>primary_author: Price, Kurt F</p><p>title: Pricing Medicare's diagnosis-related groups: charges versus estimated costs.</p><p>volume: 11</p><p>year_period: 1989 Fall</p>]]></description></item><item><title>Clinical and sociodemographic risk factors for readmission of Medicare beneficiaries.</title><pubDate>Mon, 04 Nov 2019 02:26:59 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191009</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191009</guid><description><![CDATA[<p>abstract: In a random sample of Medicare beneficiaries, multiple logistic regression was used to examine clinical, sociodemographic, and insurance coverage risk factors for readmission within 60 days of discharge. The patients most likely to be readmitted were those with poor health status or with chronic diseases and those who had not had surgery. Age, marital status, living situation, and having insurance to supplement Medicare were not independently predictive of readmission risk. The dominant roles of health status, diagnosis, and surgery as predictors of readmission provide evidence that risk-adjusted readmission rates can be equitably used for quality of care studies.</p><p>authors: Shapiro, Letitia; Thomas, J William</p><p>issue_mesh: Demography : Health Status : Hospitals/utilization : Medicare/utilization : Michigan : Models, Statistical : Patient Readmission/statistics &#x26; numerical data : Regression Analysis : Risk Factors : Socioeconomic Factors : United States</p><p>issue_number: 1</p><p>ntis_number: PB89-188478</p><p>page_range: 27-36</p><p>primary_author: Holloway, James J</p><p>title: Clinical and sociodemographic risk factors for readmission of Medicare beneficiaries.</p><p>volume: 10</p><p>year_period: 1988 Fall</p>]]></description></item><item><title>Nursing home cost studies and reimbursement issues.</title><pubDate>Mon, 04 Nov 2019 02:26:59 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191060</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191060</guid><description><![CDATA[<p>abstract: This review of nursing home cost function research shows that certain provider and service characteristics are systematically associated with differences in the average cost of care. This information can be used to group providers for reasonable cost related rate-setting or to adjust their rates or rate ceilings. However, relationships between average cost and such service characteristics as patient mix, service intensity, and quality of care have not been fully delineated. Therefore, econometric cost functions cannot yet provide rate-setters with predictions about the cost of the efficient provision of nursing home care appropriate to patient needs. In any case, the design of reimbursement systems must be founded not only on technical information but also on public policy goals for long-term care.</p><p>authors: N/A</p><p>issue_mesh: Costs and Cost Analysis : Insurance, Health, Reimbursement/economics : Insurance, Health/economics : Medicaid/economics : Nursing Homes/economics : Rate Setting and Review : Support, U.S. Gov't, P.H.S. : United States</p><p>issue_number: 4</p><p>ntis_number: PB81-112815</p><p>page_range: 47-64</p><p>primary_author: Bishop, Christine E</p><p>title: Nursing home cost studies and reimbursement issues.</p><p>volume: 1</p><p>year_period: 1980 Spring</p>]]></description></item><item><title>Predicting hospital accounting costs.</title><pubDate>Mon, 04 Nov 2019 02:26:59 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191070</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191070</guid><description><![CDATA[<p>abstract: Two alternative methods to Medicare Cost Reports that provide information about hospital costs more promptly but less accurately are investigated. Both employ utilization data from current-year bills. The first attaches costs to utilization data using cost-charge ratios from the previous year's cost report; the second uses charges from current year's bills. The first method is the more accurate of the two, but even using it, only 40 percent of hospitals had predicted costs within plus or minus 5 percent of actual costs. The feasibility and cost of obtaining cost reports from a small, fast-track sample of hospitals should be investigated.</p><p>authors: Cretin, Shan; Witsberger, Christina J</p><p>issue_mesh: Accounting/methods : Catchment Area (Health) : Costs and Cost Analysis/trends : Economics, Hospital/statistics &#x26; numerical data : Fees and Charges : Hospital Bed Capacity : Medicare/utilization : Ownership : Prospective Payment System : Regression Analysis : Support, U.S. Gov't, Non-P.H.S. : United States</p><p>issue_number: 1</p><p>ntis_number: PB90-146705</p><p>page_range: 25-33</p><p>primary_author: Newhouse, Joseph P</p><p>title: Predicting hospital accounting costs.</p><p>volume: 11</p><p>year_period: 1989 Fall</p>]]></description></item><item><title>Risk differential between Medicare beneficiaries enrolled and not enrolled in an HMO.</title><pubDate>Mon, 04 Nov 2019 02:26:59 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191056</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191056</guid><description><![CDATA[<p>abstract: Medicare provides incentive reimbursements to health maintenance organizations (HMOs) which enroll Medicare beneficiaries on a risk option and provide care at a lower cost than expected. The incentive reimbursements are tied to an actuarial calculation of Medicare Adjusted Average Per Capita Cost (AAPCC). The AAPCC adjusts for a number of variables which affect Medicare reimbursements and for which data are available: place of residence, age, sex, welfare status, and institutional status of beneficiaries. These factors account for much of the expected difference in health care reimbursements. They do not, however, account for differences in health status. Because of this, AAPCC calculations of expected costs may be too high if a selected group of beneficiaries is healthier than average, or too low if the selected group has a poorer health status than average. This case study examines the utilization behavior and reimbursement experience of a group of Medicare beneficiaries prior to their joining an HMO (during an open enrollment period) under a risk-sharing option. Their use was compared with a comparable Medicare population (the comparison group) to determine if their usage rates were greater, equal, or less than average. Results show that beneficiaries who joined during open enrollment had a rate of hospital inpatient use over 50 percent below the comparison group and a reimbursement rate for inpatient services 47 percent below the comparison group. These beneficiaries' use of Part B services also appears to be lower than the comparison group. These results must be interpreted with care. The information came from a single case study. Specific aspects of the open enrollment process, described in the paper, further limit the general liability of the findings. Also, while some studies of the same subject support the results, many others do not.</p><p>authors: N/A</p><p>issue_mesh: Reimbursement Mechanisms : Reimbursement, Incentive : Actuarial Analysis : Comparative Study : Health Maintenance Organizations/economics : Hospitals/utilization : Medicare/economics : Risk : Washington</p><p>issue_number: 3</p><p>ntis_number: PB81-112831</p><p>page_range: 91-99</p><p>primary_author: Eggers, Paul W</p><p>title: Risk differential between Medicare beneficiaries enrolled and not enrolled in an HMO.</p><p>volume: 1</p><p>year_period: 1980 Winter</p>]]></description></item><item><title>Use and cost of skilled nursing facility services under Medicare, 1987.</title><pubDate>Mon, 04 Nov 2019 02:26:59 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191076</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191076</guid><description><![CDATA[<p>abstract: The data in this article are focused on the use, covered charges, and Medicare program payments for skilled nursing services during calendar year 1987. Data for the period 1971-87 are included to show trends in the use and cost of skilled nursing facility services under the Medicare program. The impact of the Medicare prospective payment system on skilled nursing facility use is also discussed.</p><p>authors: Keene, Roger E</p><p>issue_mesh: Data Collection : Medicare/utilization : Skilled Nursing Facilities/economics/utilization : Statistics : United States</p><p>issue_number: 1</p><p>ntis_number: PB90-146705</p><p>page_range: 105-116</p><p>primary_author: Latta, Viola B</p><p>title: Use and cost of skilled nursing facility services under Medicare, 1987.</p><p>volume: 11</p><p>year_period: 1989 Fall</p>]]></description></item><item><title>Physician charges and utilization trends.</title><pubDate>Mon, 04 Nov 2019 02:26:59 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191077</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191077</guid><description><![CDATA[<p>abstract: A synopsis of charge and payment trends of Medicare physicians and other noninstitutional suppliers of goods and services is provided in this article. Included are longitudinal variations in charges for services, trends in program expenditures, and patterns in beneficiary liabilities.</p><p>authors: Fisher, Charles R</p><p>issue_mesh: Data Collection : Fees, Medical/trends : Health Expenditures/statistics &#x26; numerical data : Medicare Assignment : Medicare/utilization : Physicians/utilization : United States</p><p>issue_number: 1</p><p>ntis_number: PB90-146705</p><p>page_range: 117-123</p><p>primary_author: Edwards, Winston O</p><p>title: Physician charges and utilization trends.</p><p>volume: 11</p><p>year_period: 1989 Fall</p>]]></description></item><item><title>What can Europeans learn from Americans?</title><pubDate>Mon, 04 Nov 2019 02:26:59 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191066</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191066</guid><description><![CDATA[<p>ntis_number: PB90-172255</p><p>page_range: 49-63; discussion 63-77</p><p>primary_author: Enthoven, Alain C</p><p>title: What can Europeans learn from Americans?</p><p>volume: Supp.</p><p>year_period: 1989 Supp.</p>]]></description></item><item><title>Factors affecting differences in Medicare reimbursements for physicians' services.</title><pubDate>Mon, 04 Nov 2019 02:26:59 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191058</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191058</guid><description><![CDATA[<p>abstract: Under Medicare's Part B program, wide variations are found in average reimbursements for physicians' services by demographic and geographic characteristics of the beneficiaries. Average reimbursements per beneficiary enrolled in the program depend upon the percentage of enrolled persons who exceed the deductible and receive reimbursements, the average allowed charge per service, and the number of services used. This study analyzes differences in average reimbursements per beneficiary for physicians' services in 1975 and discusses allowed charges and use factors that affect average reimbursements. Differences in the level of allowed charges and their impact on meeting the annual deductible are also discussed. The study indicates that average reimbursements per beneficiary are likely to continue to vary significantly year after year under the present Part B cost-sharing and reimbursement mechanisms.</p><p>authors: Hackerman, Carl; Newton, Marilyn</p><p>issue_mesh: Reimbursement Mechanisms : Analysis of Variance : Fees, Medical : Insurance, Physician Services/economics : Medicare/economics/utilization : United States</p><p>issue_number: 4</p><p>ntis_number: PB81-112815</p><p>page_range: 15-37</p><p>primary_author: Gornick, Marian</p><p>title: Factors affecting differences in Medicare reimbursements for physicians' services.</p><p>volume: 1</p><p>year_period: 1980 Spring</p>]]></description></item><item><title>Growth of the Medicare population.</title><pubDate>Mon, 04 Nov 2019 02:26:59 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191033</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191033</guid><description><![CDATA[<p>abstract: The growth rate of Medicare enrollees significantly exceeds the growth rate of the general population. Moreover, the group of enrollees aged 85 years or over is growing proportionately faster than all other groups of the aged. These phenomena and other interesting trends of the Medicare population are explored in this article.</p><p>authors: N/A</p><p>issue_mesh: Aged, 80 and over : Aged : Data Collection : Human : Medicare/utilization : Population Dynamics : Statistics : United States</p><p>issue_number: 3</p><p>ntis_number: PB89-208953</p><p>page_range: 123-124</p><p>primary_author: Mariano, L Antonio</p><p>title: Growth of the Medicare population.</p><p>volume: 10</p><p>year_period: 1989 Spring</p>]]></description></item><item><title>Responsibility of families for their severely disabled elders.</title><pubDate>Mon, 04 Nov 2019 02:26:59 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191054</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191054</guid><description><![CDATA[<p>abstract: In the past 13 years, total expenditures for nursing home care under the Medicaid program have increased drastically. They show no signs of abating. Government, therefore, has become aware of the need to control this rapid increase. Families, who currently provide a large amount of informal, long-term care for their disabled elderly, are seen as a potential resource to maintain people in the community. Although demographic elements appear to mitigate against increased family responsibility, governmental incentives may be able to reverse the trend. While demographic variables cannot be modified by public policies, programs can be developed to modify family situations, increasing family capacity--and willingness--to care for disabled, elderly adults.</p><p>authors: Diamond, Lawrence D; Giele, Janet Z; Morris, Robert</p><p>issue_mesh: Family : Aged : Demography : Financing, Government : Home Nursing/economics : Human : Long-Term Care/trends : Medicaid/economics : Nursing Homes/utilization : Social Responsibility : United States</p><p>issue_number: 3</p><p>ntis_number: PB81-112831</p><p>page_range: 29-48</p><p>primary_author: Callahan Jr, James J</p><p>title: Responsibility of families for their severely disabled elders.</p><p>volume: 1</p><p>year_period: 1980 Winter</p>]]></description></item><item><title>Controlling the cost of drugs: the Canadian experience.</title><pubDate>Mon, 04 Nov 2019 02:26:59 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191051</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191051</guid><description><![CDATA[<p>abstract: In 1969 Canada began programs at both the national and provincial levels to lower prescription drug prices. These programs may have contributed to a significant decline between 1970 and 1974 of 39 percent in the average price of 16 drugs selected for study. During this time, the average price for the same drugs in the United States declined only 1.4 percent. One major program, a change in the compulsory patent licensing, is described and analyzed. Other Canadian programs, designed to promote competition in the drug industry, and their efforts are discussed.</p><p>authors: Dickens 3d, Paul F</p><p>issue_mesh: Costs and Cost Analysis : Legislation, Drug : Canada : Comparative Study : Drug Industry/economics : Prescriptions, Drug/economics : Therapeutic Equivalency : United States</p><p>issue_number: 2</p><p>ntis_number: PB81-112807</p><p>page_range: 55-64</p><p>primary_author: Fulda, Thomas K</p><p>title: Controlling the cost of drugs: the Canadian experience.</p><p>volume: 1</p><p>year_period: 1979 Fall</p>]]></description></item><item><title>Trends in Medicare enrollee use of physician and supplier services, 1983-86.</title><pubDate>Mon, 04 Nov 2019 02:26:59 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191007</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191007</guid><description><![CDATA[<p>abstract: Beginning in 1984, the long-term trend of increasing utilization of inpatient hospital care by Medicare enrollees reversed. As Medicare patients increasingly received care in outpatient hospital facilities, ambulatory surgical centers, and physicians' offices, the structure of charges for physicians' services changed significantly. Medical services by physicians in inpatient hospitals declined rapidly. Surgical care for less life-threatening illnesses, such as eye conditions, moved from inpatient hospitals to outpatient facilities and physicians' charges derived from inpatient care was offset primarily by the increased proportion derived from physician care in outpatient facilities, mostly for surgery.</p><p>authors: N/A</p><p>issue_mesh: Ambulatory Care/utilization : Fee Schedules : Hospitals/utilization : Insurance, Physician Services/statistics &#x26; numerical data : Length of Stay : Medicare/statistics &#x26; numerical data : United States</p><p>issue_number: 1</p><p>ntis_number: PB89-188478</p><p>page_range: 1-16</p><p>primary_author: Fisher, Charles R</p><p>title: Trends in Medicare enrollee use of physician and supplier services, 1983-86.</p><p>volume: 10</p><p>year_period: 1988 Fall</p>]]></description></item><item><title>Utilization and expenditures under Medicaid for Supplemental Security Income disabled.</title><pubDate>Mon, 04 Nov 2019 02:26:59 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191069</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191069</guid><description><![CDATA[<p>abstract: Recently available data on major disabling conditions of the Supplemental Security Income disabled are used to examine 1984 patterns of Medicaid expenditures in California, Georgia, Michigan, and Tennessee. Results indicate that 37-58 percent of these expenditures are for enrollees whose major disabling condition involves mental retardation or other mental disorders. This pattern occurs because a high proportion of disabled enrollees have these conditions, rather than high expenses per enrollee. Annual Medicaid expenditures per enrollee were highest for the disabled with neoplasms, blood disorders, and genitourinary conditions. Expenditures per enrollee were higher for younger enrollees and lower for those dually enrolled in Medicare.</p><p>authors: Ellwood, Marilyn R; Pine, Penelope L</p><p>issue_mesh: Disabled Persons : Mental Retardation : Adolescence : Adult : Age Factors : Aged : California : Child : Child, Preschool : Data Collection : Disease : Female : Georgia : Health Expenditures/statistics &#x26; numerical data : Human : Infant : Infant, Newborn : Male : Medicaid/utilization : Michigan : Middle Age : Support, U.S. Gov't, Non-P.H.S. : Tennessee : United States</p><p>issue_number: 1</p><p>ntis_number: PB90-146705</p><p>page_range: 1-24</p><p>primary_author: Adams, E Kathleen</p><p>title: Utilization and expenditures under Medicaid for Supplemental Security Income disabled.</p><p>volume: 11</p><p>year_period: 1989 Fall</p>]]></description></item><item><title>Medicaid utilization control programs: results of a 1987 study.</title><pubDate>Mon, 04 Nov 2019 02:26:58 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191041</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191041</guid><description><![CDATA[<p>abstract: Medicaid agencies use both second surgical opinion programs (SSOP's) and inpatient hospital preadmission review programs to control utilization of services and thus program expenditures. This article reports on the 13 mandatory and 7 voluntary SSOP's and the 21 inpatient preadmission review programs, based on responses from 44 State Medicaid agencies.</p><p>authors: N/A</p><p>issue_mesh: Referral and Consultation : Utilization Review : Comparative Study : Cost Control : Data Collection : Hospitals/utilization : Medicaid/organization &#x26; administration : Patient Admission/organization &#x26; administration : Surgical Procedures, Operative/economics : United States</p><p>issue_number: 4</p><p>ntis_number: PB89-232342</p><p>page_range: 79-92</p><p>primary_author: Lindsey, Phoebe A</p><p>title: Medicaid utilization control programs: results of a 1987 study.</p><p>volume: 10</p><p>year_period: 1989 Summer</p>]]></description></item><item><title>Factors influencing readmission risk: implications for quality monitoring.</title><pubDate>Mon, 04 Nov 2019 02:26:58 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191081</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191081</guid><description><![CDATA[<p>abstract: By applying multiple logistic regression to data from the 1980 National Medical Care Utilization and Expenditure Survey, independent risk factors for readmission to an acute care hospital within 31 days of the preceding discharge were identified. Subjects who were initially admitted for a high-risk condition, those with poor perceived health status, and those who had no surgical procedures performed were most likely to be readmitted. Sex, race, marital status, insurance coverage, and access to outpatient care did not independently influence readmission risk. Readmission risk models used to monitor quality of care need not adjust for these nonmedical factors.</p><p>authors: Thomas, J William</p><p>issue_mesh: Health Status Indicators : Risk Factors : Data Collection : Hospitals/utilization : Human : Patient Readmission/statistics &#x26; numerical data : Quality of Health Care : Regression Analysis : Support, Non-U.S. Gov't : United States/epidemiology</p><p>issue_number: 2</p><p>ntis_number: PB90-204629</p><p>page_range: 19-32</p><p>primary_author: Holloway, James J</p><p>title: Factors influencing readmission risk: implications for quality monitoring.</p><p>volume: 11</p><p>year_period: 1989 Winter</p>]]></description></item><item><title>Adjusting capitation rates using objective health measures and prior utilization.</title><pubDate>Mon, 04 Nov 2019 02:26:58 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191027</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191027</guid><description><![CDATA[<p>abstract: Several analysts have proposed adding adjusters based on health status and prior utilization to the adjusted average per capita cost formula. The authors estimate how well such adjusters predict annual medical expenditures among non-elderly adults. Both measures substantially improve on the variables currently used. If only health measures are added, 20-30 percent of the predictable variance is explained; if only prior use is added, more than 40 percent is explained; if both are added, about 60 percent is explained. The results support including some measure of use in the formula until better health measures are developed.</p><p>authors: Keeler, Emmett B; Manning Jr, Willard G; Sloss, Elizabeth M</p><p>issue_mesh: Health : Health Status : Actuarial Analysis : Aged : Capitation Fee/standards : Data Collection : Demography : Fees and Charges/standards : Health Expenditures/statistics &#x26; numerical data : Health Maintenance Organizations/utilization : Human : Medicare/utilization : Models, Statistical : Probability : Support, Non-U.S. Gov't : Support, U.S. Gov't, Non-P.H.S. : United States</p><p>issue_number: 3</p><p>ntis_number: PB89-208953</p><p>page_range: 41-54</p><p>primary_author: Newhouse, Joseph P</p><p>title: Adjusting capitation rates using objective health measures and prior utilization.</p><p>volume: 10</p><p>year_period: 1989 Spring</p>]]></description></item><item><title>Differences by age groups in health care spending.</title><pubDate>Mon, 04 Nov 2019 02:26:58 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191061</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191061</guid><description><![CDATA[<p>abstract: This paper presents differences by age in health care spending by type of expenditure and by source of funds through 1978. Use of health care services generally increases with age. The average health bill reached $2,026 for the aged in 1978, $764 for the intermediate age group, and $286 for the young. Biological, demographic, and policy factors determine each age group's share of health spending. Public funds financed over three-fifths of the health expenses of the aged, with Medicare and Medicaid together accounting for 58 percent. Most of the health expenses of the young age groups were paid by private sources.</p><p>authors: N/A</p><p>issue_mesh: Age Factors : Health Expenditures : Adolescence : Adult : Aged : Child : Child, Preschool : Health Policy : Health Services/utilization : Human : Infant : Infant, Newborn : Middle Age : United States</p><p>issue_number: 4</p><p>ntis_number: PB81-112815</p><p>page_range: 65-90</p><p>primary_author: Fisher, Charles R</p><p>title: Differences by age groups in health care spending.</p><p>volume: 1</p><p>year_period: 1980 Spring</p>]]></description></item><item><title>National health expenditures, 1987.</title><pubDate>Mon, 04 Nov 2019 02:26:58 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191023</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191023</guid><description><![CDATA[<p>abstract: The 1987 national health expenditure estimates are examined from different perspectives in the following two articles. In the first article, revised expenditure estimates for 1984-87 are presented. A breakdown of the type of services and products purchased is included, as well as the source of funds used to finance health care. In the second article, health care expenditure estimates are used to explore marginal analysis as a policy tool for understanding health spending in relation to our Nation's ability to finance that spending. The concept of marginal analysis is also used to examine selected periods that were relevant to health policy and the timing of public and private changes in health policy in the past.</p><p>authors: Levit, Katharine R; Waldo, Daniel R</p><p>issue_mesh: Health Expenditures/classification/statistics &#x26; numerical data : Insurance, Health/statistics &#x26; numerical data : Medicaid/statistics &#x26; numerical data : Medicare/statistics &#x26; numerical data : United States</p><p>issue_number: 2</p><p>ntis_number: PB89-188486</p><p>page_range: 109-122</p><p>primary_author: Letsch, Suzanne W</p><p>title: National health expenditures, 1987.</p><p>volume: 10</p><p>year_period: 1988 Winter</p>]]></description></item><item><title>Medicaid eligibility for persons in nursing homes.</title><pubDate>Mon, 04 Nov 2019 02:26:58 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191021</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191021</guid><description><![CDATA[<p>abstract: Presented in this article is an overview of Medicaid policies affecting persons in nursing homes and other institutions that provide long-term care--the criteria they must meet to qualify for Medicaid and the costs of care paid by the Medicaid program and by Medicaid recipients themselves. Underlying these complex policies, and creating sometimes peculiar consequences, is the fact that the population served in institutions and the nature of the benefit are different from the Medicaid program in general, although many of the rules affecting eligibility are the same.</p><p>authors: N/A</p><p>issue_mesh: Aged : Eligibility Determination/legislation &#x26; jurisprudence : Human : Income : Long-Term Care/economics : Medicaid/legislation &#x26; jurisprudence : Nursing Homes/economics : United States</p><p>issue_number: 2</p><p>ntis_number: PB89-188486</p><p>page_range: 67-77</p><p>primary_author: Carpenter, Letty</p><p>title: Medicaid eligibility for persons in nursing homes.</p><p>volume: 10</p><p>year_period: 1988 Winter</p>]]></description></item><item><title>To sign or not to sign: physician participation in Medicare, 1984.</title><pubDate>Mon, 04 Nov 2019 02:26:58 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191008</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191008</guid><description><![CDATA[<p>abstract: Factors leading physicians to sign the 1984 Medicare participation agreement are assessed in this study. The decision was highly sensitive to Medicare reimbursement levels. A 10-percent increase in the Medicare reasonable charge increased average participation rates by 9.5 percent, or 3.2 percentage points (around the mean of 34 percent). Higher collection costs associated with obtaining that payment from Medicare discourage participation, and physicians with large Medicare caseloads were more likely to participate. Although board-certified physicians were no less likely to participate, graduates from non-English speaking non-Western European medical schools were more likely to sign. Physicians in more liberal States and in areas with greater health maintenance organization activity were significantly more likely to participate, as were those with lower malpractice costs and weaker private demand.</p><p>authors: Cromwell, Jerry L; Rosenbach, Margo L</p><p>issue_mesh: Data Collection : Decision Making : Insurance, Physician Services/statistics &#x26; numerical data : Medicare Assignment/statistics &#x26; numerical data : Medicare/statistics &#x26; numerical data : Regression Analysis : Specialties, Medical/economics : Support, U.S. Gov't, Non-P.H.S. : United States</p><p>issue_number: 1</p><p>ntis_number: PB89-188478</p><p>page_range: 17-26</p><p>primary_author: Mitchell, Janet B</p><p>title: To sign or not to sign: physician participation in Medicare, 1984.</p><p>volume: 10</p><p>year_period: 1988 Fall</p>]]></description></item><item><title>Assessing potential prescription reimbursement changes: estimated acquisition costs in Wisconsin.</title><pubDate>Mon, 04 Nov 2019 02:26:58 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191029</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191029</guid><description><![CDATA[<p>abstract: Potential impacts from two methods of changing prescription drug ingredient reimbursement in the Wisconsin Medicaid program were estimated. Current reimbursement amounts were compared with those resulting from either direct prices for eight manufacturers' products and average wholesale price less 10.5 percent for other products or wholesaler cost plus 5.01 percent for all products. The resulting overall average ingredient cost reimbursement reductions were 6.64 percent ($0.56 per prescription) and 6.94 percent ($0.59 per prescription) for the two methods, respectively. The results should be viewed from the perspective of both program savings and reduced pharmacists' revenues.</p><p>authors: N/A</p><p>issue_mesh: Comparative Study : Costs and Cost Analysis/statistics &#x26; numerical data : Data Collection : Insurance, Pharmaceutical Services/statistics &#x26; numerical data : Medicaid/statistics &#x26; numerical data : Prescriptions, Drug/economics : Reimbursement Mechanisms/economics : Support, Non-U.S. Gov't : Wisconsin</p><p>issue_number: 3</p><p>ntis_number: PB89-208953</p><p>page_range: 67-75</p><p>primary_author: Kreling, David H</p><p>title: Assessing potential prescription reimbursement changes: estimated acquisition costs in Wisconsin.</p><p>volume: 10</p><p>year_period: 1989 Spring</p>]]></description></item><item><title>Expenditures for ambulatory episodes of care: the Michigan Medicaid experience.</title><pubDate>Mon, 04 Nov 2019 02:26:58 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191083</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191083</guid><description><![CDATA[<p>abstract: It is widely accepted that ambulatory care furnished in hospital outpatient department (OPD) settings is more costly than similar care furnished in office settings, but few researchers have explored whether practice patterns differ between the two settings. Differences in practice patterns may account for differences in the overall cost of care associated with these settings. Diagnosis-specific episodes of care were used to compare the costs of treating disease episodes in OPDs and offices. The findings suggest that OPD care is more costly not only because of price, but also because continuity of care is less common and the likelihood of hospital admission is substantially greater.</p><p>authors: Dutton Jr, Benson L</p><p>issue_mesh: Adult : Aid to Families with Dependent Children/statistics &#x26; numerical data : Child : Comparative Study : Data Collection : Demography : Health Expenditures/statistics &#x26; numerical data : Human : Medicaid/statistics &#x26; numerical data : Michigan : Office Visits/economics : Outpatient Clinics, Hospital/economics : Patient Admission/statistics &#x26; numerical data : Physician's Practice Patterns/economics : Regression Analysis</p><p>issue_number: 2</p><p>ntis_number: PB90-204629</p><p>page_range: 43-55</p><p>primary_author: McDevitt, Roland D</p><p>title: Expenditures for ambulatory episodes of care: the Michigan Medicaid experience.</p><p>volume: 11</p><p>year_period: 1989 Winter</p>]]></description></item><item><title>Medicare assignment rates of physicians: their responses to changes in reimbursement policy.</title><pubDate>Mon, 04 Nov 2019 02:26:58 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191055</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191055</guid><description><![CDATA[<p>abstract: A physician's Medicare assignment rate is one measure of his or her willingness to participate in the Medicare program. The assignment rate reflects the proportion of services provided to Medicare beneficiaries for which the physician accepts the Medicare reasonable fee as payment in full. Generally, Medicare reasonable fees are lower than the payment which a physician receives from providing the same service to a private patient or to a Medicare patient who is not treated on assignment. Because Medicare eligibles not treated on an assigned basis are financially liable for the difference between the physician's charge and the Medicare reasonable fee, the assignment rate is an indication of the out-of-pocket costs borne by Medicare eligibles. One factor which may affect the willingness of physicians to accept patients on assignment is the difference between the reimbursement which he or she may receive in the private market and the fee received from treating Medicare eligibles on assignment; Throughout this paper we assume that the physician's private price or billed charge is equivalent to the level of reimbursement received from treating privately insured patients and Medicare non-assigned patients. Since the level of reimbursement is generally no greater than the billed charge and may be less, this assumption may overstate the actual reimbursement received by the physician. In all instances, reimbursement refers to the aggregate amount received by the physician from all sources for a given service. The lower a physician's Medicare reasonable fee relative to the private market fee the less willing he/she may be to participate in Medicare assignment. This paper examines the effect of changes in Medicare reimbursement on the assignment rates of physicians. It also predicts Medicare assignment rates under a policy option which would increase Medicare reasonable fees to the level of prevailing fees.</p><p>authors: N/A</p><p>issue_mesh: Fees, Medical : Insurance, Health : Insurance, Health, Reimbursement : Attitude of Health Personnel : Medicare/economics : Physicians : United States</p><p>issue_number: 3</p><p>ntis_number: PB81-112831</p><p>page_range: 75-89</p><p>primary_author: Paringer, Lynn</p><p>title: Medicare assignment rates of physicians: their responses to changes in reimbursement policy.</p><p>volume: 1</p><p>year_period: 1980 Winter</p>]]></description></item><item><title>Health care indicators: community hospital statistics; employment, hours, and earnings in the private health sector; health care prices; and national economic indicators.</title><pubDate>Mon, 04 Nov 2019 02:26:58 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191078</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191078</guid><description><![CDATA[<p>authors: Maple, Brenda T</p><p>issue_mesh: Economics : Employment/statistics &#x26; numerical data : Fees and Charges/statistics &#x26; numerical data : Hospitals, Community/statistics &#x26; numerical data : Private Practice/statistics &#x26; numerical data : Salaries and Fringe Benefits/statistics &#x26; numerical data : United States : Urban Population</p><p>issue_number: 1</p><p>ntis_number: PB90-146705</p><p>page_range: 125-144</p><p>primary_author: Donham, Carolyn S</p><p>title: Health care indicators: community hospital statistics; employment, hours, and earnings in the private health sector; health care prices; and national economic indicators.</p><p>volume: 11</p><p>year_period: 1989 Fall</p>]]></description></item><item><title>Developing payment refinements and reforms under Medicare for excluded hospitals.</title><pubDate>Mon, 04 Nov 2019 02:26:58 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191031</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191031</guid><description><![CDATA[<p>abstract: Four classes of specialty hospitals (children's, psychiatric, rehabilitation, and long-term) and two types of distinct-part units in general hospitals (psychiatric and rehabilitation) have been excluded from the Medicare hospital prospective payment system since it was enacted by Congress in 1983. The number of these facilities and the Medicare dollars expended have more than doubled in less than 5 years, prompting renewed policy interest in developing payment reform. In this context, the substantial research and policy development efforts to refine case-mix classification and payment policies for these facilities are reviewed and examined. Findings are discussed relative to possible legislative and regulatory directions.</p><p>authors: Dobson, Allen; Iezzoni, Lisa I; Jencks, Stephen F; Willis, Patricia</p><p>issue_mesh: Data Collection : Hospitals, Pediatric/economics : Hospitals, Psychiatric/economics : Hospitals, Special/economics : Medicare/organization &#x26; administration : Prospective Payment System/methods : Rehabilitation Centers/economics : Tax Equity and Fiscal Responsibility Act : United States : United States Health Care Financing Administration</p><p>issue_number: 3</p><p>ntis_number: PB89-208953</p><p>page_range: 91-107</p><p>primary_author: Langenbrunner, John C</p><p>title: Developing payment refinements and reforms under Medicare for excluded hospitals.</p><p>volume: 10</p><p>year_period: 1989 Spring</p>]]></description></item><item><title>Toward developing a relative value scale for medical and surgical services.</title><pubDate>Mon, 04 Nov 2019 02:26:58 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191049</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191049</guid><description><![CDATA[<p>abstract: A methodology has been developed to determine the relative values of surgical procedures and medical office visits on the basis of resource costs. The time taken to perform the service and the complexity of that service are the most critical variables. Inter-specialty differences in the opportunity costs of training and overhead expenses are also considered. Results indicate some important differences between the relative values based on resource costs and existing standards, prevailing Medicare charges, and California Relative Value Study values. Most dramatic are discrepancies between existing reimbursement levels and resource cost values for office visits compared to surgical procedures. These vary from procedure to procedure and specialty to specialty but indicate that, on the average, office visits are undervalued (or surgical procedures overvalued) four- to five-fold. After standardizing the variations in the complexity of different procedures, the hourly reimbursement rate in 1978 ranged from $40 for a general practitioner to $200 for surgical specialists.</p><p>authors: Stason, William B</p><p>issue_mesh: Fee Schedules : Insurance, Health, Reimbursement : Models, Theoretical : Personal Health Services/economics : Practice Management, Medical/economics : Surgery/economics : Task Performance and Analysis : Time Factors : United States</p><p>issue_number: 2</p><p>ntis_number: PB81-112807</p><p>page_range: 23-38</p><p>primary_author: Hsiao, William C</p><p>title: Toward developing a relative value scale for medical and surgical services.</p><p>volume: 1</p><p>year_period: 1979 Fall</p>]]></description></item><item><title>Capitation payment: using predictors for medical utilization to adjust rates.</title><pubDate>Mon, 04 Nov 2019 02:26:58 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191011</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191011</guid><description><![CDATA[<p>abstract: The current adjusted average per capita cost methodology has been strongly criticized because the subgroup classifications explain minimal interpatient variation in utilization, therefore providing incentives for biased selection. In this article, we review previous investigations of predictors of medical utilization that might be included in the adjusted average per capita cost: perceived health status, functional health status, prior utilization, clinical descriptors, sociodemographic characteristics, and other miscellaneous patient characteristics. The existing data are analyzed to assess what is known about the relative strength of various predictors. Gaps in the available literature and the implications for future research and policy are discussed.</p><p>authors: Cumella, Edward J</p><p>issue_mesh: Capitation Fee : Fees and Charges : Aged : Data Collection : Demography : Health Maintenance Organizations/utilization : Health Status Indicators : Human : Medicare/utilization : Models, Statistical : Probability : Rate Setting and Review : Socioeconomic Factors : Support, Non-U.S. Gov't : United States</p><p>issue_number: 1</p><p>ntis_number: PB89-188478</p><p>page_range: 51-69</p><p>primary_author: Epstein, Arnold M</p><p>title: Capitation payment: using predictors for medical utilization to adjust rates.</p><p>volume: 10</p><p>year_period: 1988 Fall</p>]]></description></item><item><title>A descriptive analysis of medical malpractice insurance premiums, 1974-1977.</title><pubDate>Mon, 04 Nov 2019 02:26:58 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191052</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191052</guid><description><![CDATA[<p>authors: N/A</p><p>issue_mesh: Economics, Medical : Insurance, Liability/economics : Malpractice/economics : Practice Management, Medical/economics : Specialties, Medical : United States</p><p>issue_number: 2</p><p>ntis_number: PB81-112807</p><p>page_range: 65-71</p><p>primary_author: Greenspan, Nancy T</p><p>title: A descriptive analysis of medical malpractice insurance premiums, 1974-1977.</p><p>volume: 1</p><p>year_period: 1979 Fall</p>]]></description></item><item><title>Impact of Medicare on the use of medical services by disabled beneficiaries, 1972-1974.</title><pubDate>Mon, 04 Nov 2019 02:26:58 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191050</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191050</guid><description><![CDATA[<p>abstract: The extension of Medicare coverage in 1973 to disabled persons receiving cash benefits under the Social Security Act provided an opportunity to examine the impact of health insurance coverage on utilization and expenses for Part B services. Data on medical services used both before and after coverage, collected through the Current Medicare Survey, were analyzed. Results indicate that access to care (as measured by the number of persons using services) increased slightly, while the rate of use did not. The large increase in the number of persons eligible for Medicare reflected the large increase in the number of cash beneficiaries. Significant increases also were found in the amount charged for medical services. The absence of large increases in access and service use may be attributed, in part, to the already existing source of third party payment available to disabled cash beneficiaries in 1972, before Medicare coverage.</p><p>authors: N/A</p><p>issue_mesh: Disabled Persons : Health Services Accessibility : Health Services/utilization : Human : Insurance, Health, Reimbursement/economics : Insurance, Health/economics : Medicare/utilization : United States</p><p>issue_number: 2</p><p>ntis_number: PB81-112807</p><p>page_range: 39-54</p><p>primary_author: Deacon, Ronald W</p><p>title: Impact of Medicare on the use of medical services by disabled beneficiaries, 1972-1974.</p><p>volume: 1</p><p>year_period: 1979 Fall</p>]]></description></item><item><title>Use and cost of physician and supplier services under Medicare, 1986.</title><pubDate>Mon, 04 Nov 2019 02:26:58 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191032</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191032</guid><description><![CDATA[<p>abstract: There is general consensus that the present Medicare physician payment system and related policies should be revised. Therefore, the Health Care Financing Administration and Congress are examining the physician reimbursement system for potential changes that could reverse the inflationary incentives in the present system and induce greater incentives for efficiency and cost savings. Medicare program data and information are provided to assist health care managers and administrators in the development and analysis of Medicare physician research and policy initiatives. The data may also be helpful in monitoring and measuring the use and cost of Medicare physician and supplier services as related to program performance and administration.</p><p>authors: Keene, Roger E</p><p>issue_mesh: Aged : Costs and Cost Analysis/statistics &#x26; numerical data : Data Collection : Fees, Medical/statistics &#x26; numerical data : Health Expenditures/statistics &#x26; numerical data : Human : Insurance, Physician Services/utilization : Medicare Assignment : Medicare/utilization : Specialties, Medical/economics : United States : United States Health Care Financing Administration</p><p>issue_number: 3</p><p>ntis_number: PB89-208953</p><p>page_range: 109-122</p><p>primary_author: Helbing, Charles</p><p>title: Use and cost of physician and supplier services under Medicare, 1986.</p><p>volume: 10</p><p>year_period: 1989 Spring</p>]]></description></item><item><title>Longitudinal patterns of Medicare use by cause of death.</title><pubDate>Mon, 04 Nov 2019 02:26:58 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191079</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191079</guid><description><![CDATA[<p>abstract: To study the use of health services before death for different causes, a 6-year file of Medicare use and cost data was linked to a file of death certificate information for persons dying at ages 65 years or over in 1979. Patterns of medical care use during the last years of life varied substantially by cause of death, reflecting the degree of chronicity of the disease that resulted in death and the nature of treatment. Persons dying of nephritis, chronic obstructive pulmonary disease, and diabetes mellitus incurred consistently high expenses for 6 years before death. Costs for cancer decedents were also high, especially in the last 2 years of life. Persons in their last 2 years of life have a considerable impact on Medicare expenses. An estimated 13 percent of annual Medicare expenses were attributable to persons who were within 2 years of death from heart disease and 10.7 percent to persons who were within 2 years of death from cancer.</p><p>authors: Lubitz, James</p><p>issue_mesh: Cause of Death : Age Factors : Aged : Data Collection : Health Expenditures/statistics &#x26; numerical data : Health Services/utilization : Human : Longitudinal Studies : Medicare/statistics &#x26; numerical data : Models, Statistical : Population Dynamics : United States Health Care Financing Administration : United States/epidemiology</p><p>issue_number: 2</p><p>ntis_number: PB90-204629</p><p>page_range: 1-12</p><p>primary_author: Riley, Gerald F</p><p>title: Longitudinal patterns of Medicare use by cause of death.</p><p>volume: 11</p><p>year_period: 1989 Winter</p>]]></description></item><item><title>Factors affecting Medicaid patients' length of stay in psychiatric units.</title><pubDate>Mon, 04 Nov 2019 02:26:58 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191020</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191020</guid><description><![CDATA[<p>abstract: The structure of the Medicaid program varies widely among the States. Examined in this article is the relationship between certain characteristics of the State Medicaid programs and the length of stay of patients who are discharged from psychiatric units in general hospitals. It has been found that setting limits on the number of reimbursable days leads to shorter lengths of stay and that, after controlling for region, length of stay is not influenced by utilization review or State rate setting.</p><p>authors: Frank, Richard G</p><p>issue_mesh: Models, Statistical : Adolescence : Adult : Aged : Child : Data Collection : Fee Schedules : Female : Human : Length of Stay/statistics &#x26; numerical data : Male : Medicaid/organization &#x26; administration : Middle Age : Patient Discharge/statistics &#x26; numerical data : Prospective Payment System : Psychiatric Department, Hospital/utilization : Support, U.S. Gov't, P.H.S. : United States</p><p>issue_number: 2</p><p>ntis_number: PB89-188486</p><p>page_range: 57-66</p><p>primary_author: Lave, Judith R</p><p>title: Factors affecting Medicaid patients' length of stay in psychiatric units.</p><p>volume: 10</p><p>year_period: 1988 Winter</p>]]></description></item><item><title>Medicare end stage renal disease population, 1982-87.</title><pubDate>Mon, 04 Nov 2019 02:26:58 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191141</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191141</guid><description><![CDATA[<p>abstract: A synopsis is given between the relationship of the number of end stage renal disease (ESRD) patients to the total Medicare population and their associated expenditures. The aging trend within the ESRD population is examined in terms of enrollment statistics and incidence (new cases) counts. Also, longitudinal trends in expenditures, program enrollment, and incidence of ESRD are included. Findings indicate that the ESRD population is growing at a faster rate than Medicare in general. Further, within ESRD, the beneficiary population is aging.</p><p>authors: Milam, Roger A; Sarsitis, Ida M</p><p>issue_mesh: Aged : Health Expenditures/statistics &#x26; numerical data : Human : Incidence : Kidney Failure, Chronic/economics/epidemiology : Medicare/statistics &#x26; numerical data : Population Surveillance : United States/epidemiology</p><p>issue_number: 1</p><p>ntis_number: PB91-176255</p><p>page_range: 101-104</p><p>primary_author: Breidenbaugh, M Zermain</p><p>title: Medicare end stage renal disease population, 1982-87.</p><p>volume: 12</p><p>year_period: 1990 Fall</p>]]></description></item><item><title>Prospective payments to hospitals: should emergency admissions have higher rates?</title><pubDate>Mon, 04 Nov 2019 02:26:56 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191026</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191026</guid><description><![CDATA[<p>abstract: Systematic variation in patient resource use can be a significant problem for a system based on diagnosis-related groups (DRG's) if this variation is not evenly distributed across hospitals. If certain hospitals routinely treat patients who require more services than average under DRG's, the long-run financial viability of these hospitals will be threatened. In this study, the authors examine whether patients who are admitted on an emergency or urgent basis represent an identifiable group of patients whose costs are systematically higher than those of electively admitted patients, controlling for DRG. Alternative approaches for incorporating admission status into a DRG payment system are developed and tested.</p><p>authors: Mann, Joyce M; Serrato, Carl A</p><p>issue_mesh: Costs and Cost Analysis/statistics &#x26; numerical data : Data Collection : Diagnosis-Related Groups/statistics &#x26; numerical data : Economics, Hospital/statistics &#x26; numerical data : Emergencies/economics : Medicare/statistics &#x26; numerical data : Models, Statistical : New Jersey : Patient Admission/economics : Prospective Payment System/standards : Regression Analysis : Support, Non-U.S. Gov't : Support, U.S. Gov't, Non-P.H.S.</p><p>issue_number: 3</p><p>ntis_number: PB89-208953</p><p>page_range: 29-39</p><p>primary_author: Melnick, Glenn A</p><p>title: Prospective payments to hospitals: should emergency admissions have higher rates?</p><p>volume: 10</p><p>year_period: 1989 Spring</p>]]></description></item><item><title>Evaluation of the national swing-bed program in rural hospitals.</title><pubDate>Mon, 04 Nov 2019 02:26:56 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191012</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191012</guid><description><![CDATA[<p>abstract: The Health Care Financing Administration (HCFA) implemented a swing-bed demonstration and evaluation program for rural communities in the 1970's. The demonstration substantiated the cost effectiveness of providing long-term care in small, rural, acute care hospitals. As a result, Section 904 of the Omnibus Reconciliation Act of 1980 (Public Law 96-499) authorized the national swing-bed program, allowing rural hospitals with fewer than 50 beds to provide Medicare- and Medicaid-covered swing-bed care. A congressionally mandated evaluation of the program was conducted and the national swing-bed program was found to be cost effective. In this article, HCFA's report and recommendations to Congress are summarized in the context of the evaluation findings. HCFA recommended that the program be continued and that consideration be given to extending the option to larger hospitals. In this regard, the Omnibus Budget Reconciliation Act of 1987 (Public Law 100-203) extended the program to include rural hospitals with up to 100 beds.</p><p>authors: Schlenker, Robert E; Silverman, Herbert A</p><p>issue_mesh: Hospital Administration : Bed Conversion/legislation &#x26; jurisprudence : Health Facility Planning/legislation &#x26; jurisprudence : Hospital Bed Capacity, under 100 : Hospitals, Rural/organization &#x26; administration : Medicaid/legislation &#x26; jurisprudence : Medicare/legislation &#x26; jurisprudence : Program Evaluation : Support, Non-U.S. Gov't : Support, U.S. Gov't, Non-P.H.S. : United States : United States Health Care Financing Administration</p><p>issue_number: 1</p><p>ntis_number: PB89-188478</p><p>page_range: 87-94</p><p>primary_author: Shaughnessy, Peter W</p><p>title: Evaluation of the national swing-bed program in rural hospitals.</p><p>volume: 10</p><p>year_period: 1988 Fall</p>]]></description></item><item><title>Are the diagnosis-related group case weights compressed?</title><pubDate>Mon, 04 Nov 2019 02:26:56 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191018</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191018</guid><description><![CDATA[<p>abstract: One problem noted recently with the diagnosis-related group payment system is that the distribution of Medicare case weights and case-mix indexes are compressed; that is, the payment rates for high-cost procedures are too low and those for low-cost procedures are too high. Despite the attention compression has received, there are no direct estimates of its magnitude or importance. Presented in this article are an empirical test for compression and a suggestion for a simple correction to decompress the relative prices.</p><p>authors: Cretin, Shan; Keeler, Emmett B</p><p>issue_mesh: Models, Statistical : Costs and Cost Analysis/statistics &#x26; numerical data : Diagnosis-Related Groups/economics : Economics, Hospital/statistics &#x26; numerical data : Fees and Charges/statistics &#x26; numerical data : Medicare/statistics &#x26; numerical data : Prospective Payment System/methods : Support, Non-U.S. Gov't : Support, U.S. Gov't, Non-P.H.S. : United States</p><p>issue_number: 2</p><p>ntis_number: PB89-188486</p><p>page_range: 37-46</p><p>primary_author: Thorpe, Kenneth E</p><p>title: Are the diagnosis-related group case weights compressed?</p><p>volume: 10</p><p>year_period: 1988 Winter</p>]]></description></item><item><title>Projections of national health expenditures, 1980, 1985, and 1990.</title><pubDate>Mon, 04 Nov 2019 02:26:56 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191053</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191053</guid><description><![CDATA[<p>abstract: This paper presents projections of national health expenditures by type of expenditure and sources of funds for 1980, 1985, and 1990. A major purpose of these projections is to provide a baseline for health care expenditures in the absence of national health insurance and cost containment. Rapid growth in health expenditures is projected to continue to 1990. National health expenditures increased 350 percent between 1965 and 1978, reaching $192 billion in 1978. They are projected to reach $245 billion in 1980, $440 billion in 1985 and $760 billion in 1990, under current legislation. As a proportion of the Gross National Product (GNP), health expenditures rose from 6.2 percent to 9.1 percent between 1965 and 1978. They are projected to continue to rise, reaching 10.5 percent by 1985 and 11.5 percent by 1990. Sources of payments for these expenditures are also shifting. From 1965 to 1978, the percentage of total health expenditures that was government financed increased 16 percentage points, from 25 to 41 percent. The Federal share of public funds during the same period grew rapidly, from 53 percent in 1965 to 69 percent in 1978. In 1985, approximately 42 percent of total health spending is projected to be financed from public funds, of which 72 percent will be paid by the Federal government. Public funds are expected to account for 43 percent of total national health expenditures by 1990.</p><p>authors: Calat, George; Schendler, Carol E</p><p>issue_mesh: Forecasting : Financing, Government/trends : Health Expenditures/trends : Health Services Research : Models, Theoretical</p><p>issue_number: 3</p><p>ntis_number: PB81-112831</p><p>page_range: 1-28</p><p>primary_author: Freeland, Mark S</p><p>title: Projections of national health expenditures, 1980, 1985, and 1990.</p><p>volume: 1</p><p>year_period: 1980 Winter</p>]]></description></item><item><title>International differences in medical care practices.</title><pubDate>Mon, 04 Nov 2019 02:26:56 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191063</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191063</guid><description><![CDATA[<p>ntis_number: PB90-172255</p><p>page_range: 9-20</p><p>primary_author: McPherson, Klim</p><p>title: International differences in medical care practices.</p><p>volume: Supp.</p><p>year_period: 1989 Supp.</p>]]></description></item><item><title>What can Americans learn from Europeans?</title><pubDate>Mon, 04 Nov 2019 02:26:56 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191067</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191067</guid><description><![CDATA[<p>ntis_number: PB90-172255</p><p>page_range: 79-93; discussion 93-110</p><p>primary_author: Jonsson, Bengt</p><p>title: What can Americans learn from Europeans?</p><p>volume: Supp.</p><p>year_period: 1989 Supp.</p>]]></description></item><item><title>Beneficiary selection, use, and charges in two Medicare capitation demonstrations.</title><pubDate>Mon, 04 Nov 2019 02:26:56 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191010</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191010</guid><description><![CDATA[<p>abstract: Findings with regard to health status, service use, and charges are presented for Medicare beneficiaries who received care under Medicare risk contracts with two health maintenance organizations from 1980 through 1982 and for fee-for-service comparison groups. Health status of plan enrollees and fee-for-service beneficiaries were compared using mortality data, preenrollment claims, and self-reported health measures. Patterns of use and expenditures during preenrollment and postenrollment periods were examined using Medicare records and data supplied by the plans.</p><p>authors: McCombs, Jeffrey S; Riley, Gerald F; Stevenson, Mary A</p><p>issue_mesh: Capitation Fee : Fees and Charges : Health : Health Status : Aged : Data Collection : Evaluation Studies : Female : Health Maintenance Organizations/utilization : Hospitals/utilization : Human : Male : Massachusetts : Medicare/statistics &#x26; numerical data : Middle Age : Mortality : Pilot Projects : Wisconsin</p><p>issue_number: 1</p><p>ntis_number: PB89-188478</p><p>page_range: 37-49</p><p>primary_author: Kasper, Judith D</p><p>title: Beneficiary selection, use, and charges in two Medicare capitation demonstrations.</p><p>volume: 10</p><p>year_period: 1988 Fall</p>]]></description></item><item><title>Do unprofitable patients face access problems?</title><pubDate>Mon, 04 Nov 2019 02:26:56 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191082</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191082</guid><description><![CDATA[<p>abstract: Tests were conducted to determine whether implementation of the prospective payment system caused access problems for patients with an above-average likelihood of being unprofitable. Since implementation, patients in diagnosis-related groups that are, on average, unprofitable are not more likely to be transferred. However, they are more likely to be found in hospitals of last resort (the only evidence from these tests indicating access problems). Outlier patients are not more likely to be found in last-resort hospitals. The access issue will continue to bear scrutiny, but there is not as yet evidence that it is a serious problem.</p><p>authors: N/A</p><p>issue_mesh: Comparative Study : Data Collection : Diagnosis-Related Groups/economics : Health Services Accessibility/statistics &#x26; numerical data : Hospitals, Municipal/utilization : Hospitals, Public/utilization : Hospitals, Urban/utilization : Hospitals/utilization : Income/statistics &#x26; numerical data : Medicare/statistics &#x26; numerical data : Patient Transfer/statistics &#x26; numerical data : Prospective Payment System/economics : Support, Non-U.S. Gov't : Support, U.S. Gov't, Non-P.H.S. : United States</p><p>issue_number: 2</p><p>ntis_number: PB90-204629</p><p>page_range: 33-42</p><p>primary_author: Newhouse, Joseph P</p><p>title: Do unprofitable patients face access problems?</p><p>volume: 11</p><p>year_period: 1989 Winter</p>]]></description></item><item><title>Prenatal, delivery, and infant care under Medicaid in three states.</title><pubDate>Mon, 04 Nov 2019 02:26:56 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191035</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191035</guid><description><![CDATA[<p>abstract: Medicaid services and expenditures were analyzed for care during the prenatal, delivery, and post-delivery periods in three States--California, Georgia, and Michigan. Uniform data were used from the Health Care Financing Administration's Medicaid Tape-to-Tape project, 1983-84. Results indicate that from 16 to 24 percent of all births in the States of the study, during the study period, were financed by Medicaid. Overall, the study showed that more than one-half of expenditures for the study population were for the delivery hospitalization, and less than 12 percent were for prenatal care. As expected, a substantial portion of expenditures were for high-cost deliveries, up to 41 percent of total delivery payments. From 33 to 41 percent of total Medicaid expenditures for Aid to Families with Dependent Children were for pregnancy, delivery, and newborn care in 1983.</p><p>authors: Brown, Gretchen A</p><p>issue_mesh: California : Data Collection : Delivery/economics : Female : Georgia : Health Expenditures/statistics &#x26; numerical data : Hospitalization/economics : Human : Medicaid/utilization : Michigan : Obstetrics/economics : Pregnancy : Prenatal Care/economics : Reimbursement Mechanisms : United States : United States Health Care Financing Administration</p><p>issue_number: 4</p><p>ntis_number: PB89-232342</p><p>page_range: 1-16</p><p>primary_author: Howell, Embry M</p><p>title: Prenatal, delivery, and infant care under Medicaid in three states.</p><p>volume: 10</p><p>year_period: 1989 Summer</p>]]></description></item><item><title>Assessing Medicare reimbursement options for skilled nursing facility care.</title><pubDate>Mon, 04 Nov 2019 02:26:56 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191025</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191025</guid><description><![CDATA[<p>abstract: In this article, a broad array of Medicare payment options for skilled nursing home care are examined, ranging from cost-based retrospective systems to various prospective arrangements. Each system contains different incentives to meet four policy goals: provide access for Medicare patients; increase access for patients requiring resource-intensive care; contain growth in program costs; and assure the delivery of high-quality care. The financial impacts of alternative policy options on nursing homes are presented through the use of a simulation model. Facility-specific payment systems are shown to most effectively incorporate incentives to contain costs and promote beneficiary access to care.</p><p>authors: Sulvetta, Margaret B</p><p>issue_mesh: Comparative Study : Computer Simulation : Data Collection : Evaluation Studies : Medicare/organization &#x26; administration : Reimbursement Mechanisms/statistics &#x26; numerical data : Skilled Nursing Facilities/economics : United States</p><p>issue_number: 3</p><p>ntis_number: PB89-208953</p><p>page_range: 13-27</p><p>primary_author: Holahan, John</p><p>title: Assessing Medicare reimbursement options for skilled nursing facility care.</p><p>volume: 10</p><p>year_period: 1989 Spring</p>]]></description></item><item><title>Physician incomes and work patterns across specialties: 1975 and 1983-84.</title><pubDate>Mon, 04 Nov 2019 02:26:56 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191016</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191016</guid><description><![CDATA[<p>abstract: Survey data on physician income and work patterns are examined and compared for 1975 and 1983-84. Specialty, hours and weeks worked, location, practice size, and incorporation status are examined. Dollar figures for 1975 are adjusted to show real-dollar income changes over the period. Incomes for surgical specialties were highest. In real-dollar terms, nonsurgical specialties exhibited sluggish growth or even fell. Urban-rural differences in real income and hours worked narrowed over time. Incorporation and group affiliation were positively related to income levels in both surveys, but number of hours worked was not. Limitations and interpretation of these data are discussed last.</p><p>authors: Terrell, Sherry A; Williams, Deborah K</p><p>issue_mesh: Income : Work : Data Collection : Professional Practice/statistics &#x26; numerical data : Questionnaires : Specialties, Medical/economics : United States</p><p>issue_number: 2</p><p>ntis_number: PB89-188486</p><p>page_range: 17-24</p><p>primary_author: Langenbrunner, John C</p><p>title: Physician incomes and work patterns across specialties: 1975 and 1983-84.</p><p>volume: 10</p><p>year_period: 1988 Winter</p>]]></description></item><item><title>National hospital input price index.</title><pubDate>Mon, 04 Nov 2019 02:26:56 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191045</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191045</guid><description><![CDATA[<p>abstract: The national community hospital input price index presented here isolates the effects of prices of goods and services required to produce hospital care and measures the average percent change in prices for a fixed market basket of hospital inputs. Using the methodology described in this article, weights for various expenditure categories were estimated and proxy price variables associated with each were selected. The index is calculated for the historical period 1970 through 1978 and forecast for 1979 through 1981. During the historical period, the input price index increased an average of 8.0 percent a year, compared with an average rate of increase of 6.6 percent for overall consumer prices. For the period 1979 through 1981, the average annual increase is forecast at between 8.5 and 9.0 per cent. Using the index to deflate growth in expenses, the level of real growth in expenditures per inpatient day (net service intensity growth) averaged 4.5 percent per year with considerable annual variation related to government and hospital industry policies.</p><p>authors: Anderson, Gerald F; Schendler, Carol E</p><p>issue_mesh: Accounts Payable and Receivable : Capital Expenditures/trends : Costs and Cost Analysis : Depreciation : Economics, Hospital/trends : Fees and Charges/trends : Forecasting/methods : Hospitals, Community/trends : Insurance, Liability/economics : Salaries and Fringe Benefits/trends : United States</p><p>issue_number: 1</p><p>ntis_number: PB81-112799</p><p>page_range: 37-61</p><p>primary_author: Freeland, Mark S</p><p>title: National hospital input price index.</p><p>volume: 1</p><p>year_period: 1979 Summer</p>]]></description></item><item><title>Use and cost of home health agency services under Medicare.</title><pubDate>Mon, 04 Nov 2019 02:26:56 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191014</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191014</guid><description><![CDATA[<p>abstract: Presented are 1986 data and trend data (1974-86) on the use and cost of home health agency services rendered to aged and disabled Medicare beneficiaries. Since 1974, reimbursements for these services have grown more rapidly than overall Medicare expenditures. From 1974 to 1986, Medicare expenditures for these services increased from $141 million to $1.8 billion, an average annual rate of 24 percent. HHA reimbursements, however, continue to represent only a small proportion (3.6 percent in 1986) of all Medicare expenditures.</p><p>authors: Helbing, Charles</p><p>issue_mesh: Aged : Data Collection : Female : Home Care Services/utilization : Human : Male : Medicare/utilization : Statistics : United States</p><p>issue_number: 1</p><p>ntis_number: PB89-188478</p><p>page_range: 105-108</p><p>primary_author: Ruther, Martin M</p><p>title: Use and cost of home health agency services under Medicare.</p><p>volume: 10</p><p>year_period: 1988 Fall</p>]]></description></item><item><title>Hospital utilization and expenditures in a Medicaid population.</title><pubDate>Mon, 04 Nov 2019 02:26:56 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191071</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191071</guid><description><![CDATA[<p>abstract: Determinants of hospital utilization and expenditures are analyzed for Medicaid enrollees in the State Medicaid household sample portion of the National Medical Care Utilization and Expenditure Survey who were continuously enrolled throughout 1980. Health status measures were the best predictors of both the probability of hospitalization and total hospitalizations. Children covered by Aid to Families with Dependent Children were the Medicaid enrollees least likely to be hospitalized. Number of hospital days, surgery, and California residence directly increased hospital expenditures. Conditions responsible for hospitalization increased hospital expenditures indirectly by increasing the number of hospital days and the probability of surgery.</p><p>authors: N/A</p><p>issue_mesh: Aid to Families with Dependent Children/utilization : California : Data Collection : Disease : Health Expenditures/statistics &#x26; numerical data : Health Status Indicators : Hospitals/utilization : Human : Medicaid/utilization : Michigan : Models, Statistical : New York : Probability : Regression Analysis : Surgery : Texas : United States</p><p>issue_number: 1</p><p>ntis_number: PB90-146705</p><p>page_range: 35-47</p><p>primary_author: Buczko, William</p><p>title: Hospital utilization and expenditures in a Medicaid population.</p><p>volume: 11</p><p>year_period: 1989 Fall</p>]]></description></item><item><title>Use and cost of short-stay hospital inpatient services under Medicare, 1986.</title><pubDate>Mon, 04 Nov 2019 02:26:56 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191042</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191042</guid><description><![CDATA[<p>abstract: This article is part of a continuing effort to monitor the operation of the Medicare program. A synopsis is given of the legislation that implemented the prospective payment system for short-stay hospitals, and the data show the program experience for 1986, the third full year of implementation under prospective payment.</p><p>authors: Keene, Roger E</p><p>issue_mesh: Data Collection : Hospitalization/statistics &#x26; numerical data : Hospitals/utilization : Inpatients : Length of Stay/statistics &#x26; numerical data : Medicare/utilization : Patient Discharge/statistics &#x26; numerical data : Prospective Payment System/legislation &#x26; jurisprudence : United States</p><p>issue_number: 4</p><p>ntis_number: PB89-232342</p><p>page_range: 93-109</p><p>primary_author: Helbing, Charles</p><p>title: Use and cost of short-stay hospital inpatient services under Medicare, 1986.</p><p>volume: 10</p><p>year_period: 1989 Summer</p>]]></description></item><item><title>Health expenditures by age group, 1977 and 1987.</title><pubDate>Mon, 04 Nov 2019 02:26:56 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191043</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191043</guid><description><![CDATA[<p>abstract: In recent years, concern has increased over the rapid growth of health care spending, especially spending on behalf of the aged. In 1987, those 65 years or over comprised 12 percent of the population but consumed 36 percent of total personal health care. This article is an examination of the current and future composition of the population and effects on health care spending. National health accounts aggregates for 1977 and 1987 are split into three age groups, and the consumption patterns of each group are discussed. The variations in spending within the aged cohort are also examined.</p><p>authors: Arnett 3d, Ross H; McKusick, David R; Sonnefeld, Sally T</p><p>issue_mesh: Adolescence : Adult : Age Factors : Aged : Child : Comparative Study : Health Expenditures/statistics &#x26; numerical data : Health Services for the Aged/economics : Human : Insurance, Health/statistics &#x26; numerical data : Medicaid/statistics &#x26; numerical data : Medicare/statistics &#x26; numerical data : Middle Age : Population : United States</p><p>issue_number: 4</p><p>ntis_number: PB89-232342</p><p>page_range: 111-120</p><p>primary_author: Waldo, Daniel R</p><p>title: Health expenditures by age group, 1977 and 1987.</p><p>volume: 10</p><p>year_period: 1989 Summer</p>]]></description></item><item><title>Patterns of Medicaid utilization and expenditures in selected states: 1980-84.</title><pubDate>Mon, 04 Nov 2019 02:26:56 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191015</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191015</guid><description><![CDATA[<p>abstract: Data from the Medicaid Tape-to-Tape project are presented for 5 years, 1980-84, and for five States--California, Georgia, Michigan, New York, and Tennessee. These States represent a range of generous to restrictive Medicaid program characteristics. Utilization and expenditure measures are presented for most Medicaid services: hospital services, long-term care, physician services, and prescription drugs. Data are further disaggregated by major eligibility group: children and adults covered by Aid to Families with Dependent Children; aged and disabled covered by Supplemental Security Income. Previous findings of a high degree of Medicaid diversity among States are confirmed here.</p><p>authors: Baugh, David K; Pine, Penelope L</p><p>issue_mesh: Adolescence : Adult : Aged : Aid to Families with Dependent Children/utilization : California : Child : Comparative Study : Data Collection : Female : Georgia : Health Expenditures/statistics &#x26; numerical data : Hospitalization/statistics &#x26; numerical data : Human : Long-Term Care/statistics &#x26; numerical data : Male : Medicaid/utilization : Michigan : Middle Age : New York : Tennessee : United States</p><p>issue_number: 2</p><p>ntis_number: PB89-188486</p><p>page_range: 1-16</p><p>primary_author: Howell, Embry M</p><p>title: Patterns of Medicaid utilization and expenditures in selected states: 1980-84.</p><p>volume: 10</p><p>year_period: 1988 Winter</p>]]></description></item><item><title>Taxation and its effect upon public and private health insurance and medical demand.</title><pubDate>Mon, 04 Nov 2019 02:26:56 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191059</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191059</guid><description><![CDATA[<p>abstract: Multiple tax subsidies are available to many buyers and sellers of health insurance. These subsidies have the potential of creating excess demand for health insurance, which in turn can create excess demand for health services. A review of the literature on the effects of the tax subsidies on the price of health care shows that these subsidies, by raising prices in the medical sector, constrain the Medicare and Medicaid programs' ability to provide access to care for their beneficiaries.</p><p>authors: Vogel, Ronald J</p><p>issue_mesh: Income Tax : Health Benefit Plans, Employee/economics : Health Services Needs and Demand/economics : Health Services Research/economics : Insurance, Health/economics : Medicaid/economics : Medical Assistance/economics : Medicare/economics : United States</p><p>issue_number: 4</p><p>ntis_number: PB81-112815</p><p>page_range: 39-45</p><p>primary_author: Greenspan, Nancy T</p><p>title: Taxation and its effect upon public and private health insurance and medical demand.</p><p>volume: 1</p><p>year_period: 1980 Spring</p>]]></description></item><item><title>Expenditures for long-term care services by community elders.</title><pubDate>Mon, 04 Nov 2019 02:26:56 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191028</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191028</guid><description><![CDATA[<p>abstract: Costs of care are presented for elderly persons in five community-based settings. These settings include elderly persons living in their own homes or in group housing and who do or do not receive case-managed home care. Expenditures for care ranged from a low of about $1,100 per year to a high of $4,025. The level of expenditure was directly related to risk of institutionalization and was higher for those receiving case-managed home care. As a majority of the elderly use a substantial amount of care even without case management, the potential for community care demonstration programs to yield significant cost savings appears quite limited.</p><p>authors: Gutkin, Claire E; Morris, John N; Sherwood, Sylvia</p><p>issue_mesh: Activities of Daily Living : Aged : Community Health Services/economics : Costs and Cost Analysis/statistics &#x26; numerical data : Data Collection : Health Expenditures/statistics &#x26; numerical data : Health Status : Home Care Services/economics : Human : Institutionalization/economics : Long-Term Care/economics : Longitudinal Studies : Risk Factors : Support, Non-U.S. Gov't : United States</p><p>issue_number: 3</p><p>ntis_number: PB89-208953</p><p>page_range: 55-65</p><p>primary_author: Ruchlin, Hirsch S</p><p>title: Expenditures for long-term care services by community elders.</p><p>volume: 10</p><p>year_period: 1989 Spring</p>]]></description></item><item><title>Evaluation of the Medicare competition demonstrations.</title><pubDate>Mon, 04 Nov 2019 02:26:56 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191085</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191085</guid><description><![CDATA[<p>abstract: A summary of findings from the Evaluation of the Medicare Competition Demonstrations is presented in this article. The purpose of this evaluation was to examine the implementation and operational experiences of the 26 health maintenance organizations that operated as demonstrations from 1983 to 1985, their experiences in marketing their plans, the factors that affected beneficiaries' decisions to join or not join a plan, the extent to which beneficiaries were satisfied with their choice of plans, the quality of care provided by the plans, and the impact of the demonstrations on Medicare beneficiaries' use and cost of services.</p><p>authors: Hadley, James P</p><p>issue_mesh: Health Services Research : Aged : Consumer Satisfaction : Costs and Cost Analysis : Data Collection : Evaluation Studies : Health Maintenance Organizations/utilization : Human : Insurance Selection Bias : Medicare/organization &#x26; administration : Pilot Projects : Quality of Health Care : Risk : Support, U.S. Gov't, Non-P.H.S. : United States</p><p>issue_number: 2</p><p>ntis_number: PB90-204629</p><p>page_range: 65-80</p><p>primary_author: Langwell, Kathryn M</p><p>title: Evaluation of the Medicare competition demonstrations.</p><p>volume: 11</p><p>year_period: 1989 Winter</p>]]></description></item><item><title>Evaluating the predictive validity of nursing home pre-admission screens.</title><pubDate>Mon, 04 Nov 2019 02:26:55 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1190240</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1190240</guid><description><![CDATA[<p>abstract: This article demonstrates a method for evaluating the predictive validity of nursing home pre-admission screens (PAS) by using measures of predictive validity adapted from the field of epidemiology. Our approach estimates how well as PAS performs in identifying the "who but for" population of the Medicaid home and community-based services waiver programs for the frail elderly. The methodology's usefulness in screen revision is also illustrated.</p><p>authors: Eichorn, Ann; Sokoloff, Sharon; VanTassel, Janet</p><p>issue_mesh: *Geriatric Assessment : Activities of Daily Living : Aged : Connecticut : Eligibility Determination/statistics</p><p>issue_number: 4</p><p>ntis_number: PB95-123485</p><p>page_range: 169-180</p><p>primary_author: Jackson, Mary E</p><p>title: Evaluating the predictive validity of nursing home pre-admission screens.</p><p>volume: 14</p><p>year_period: 1993 Summer</p>]]></description></item><item><title>Design of a prospective payment patient classification system for ambulatory care.</title><pubDate>Mon, 04 Nov 2019 02:26:55 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1190351</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1190351</guid><description><![CDATA[<p>abstract: The Ambulatory Patient Group (APGs) are a patient classification system that was developed to be used as the basis of a prospective payment system (PPS) for the facility costs of outpatient care. This article will review the key characteristics of a patient classification system for ambulatory care, describe the APG development process, and describe a payment model based on the APGs. We present the results of simulating the use of APGs in a prospective payment system, and conclude with a discussion of the implementation issues associated with an outpatient PPS.</p><p>authors: Bender, Judith A; Goldfield, Nobert I; Gregg, Laurence W; McGuire, Thomas E; Mullin, Robert L; Wynn, Mark E</p><p>issue_mesh: Ambulatory Care/classification/economics/statistics &#x26; numerical data : Ancillary Services, Hospital/classification/economics/statistics &#x26; numerical data : Diagnosis-Related Groups/classification : Episode of Care : Health Services Research : Hospital Costs/statistics &#x26; numerical data : Medicare/organization &#x26; administration : Outpatient Clinics, Hospital/economics/utilization : Prospective Payment System/organization &#x26; administration : Support, U.S. Gov't, Non-P.H.S. : United States : United States Health Care Financing Administration</p><p>issue_number: 1</p><p>ntis_number: PB95-123493</p><p>page_range: 71-100</p><p>primary_author: Averill, Richard F</p><p>title: Design of a prospective payment patient classification system for ambulatory care.</p><p>volume: 15</p><p>year_period: 1993 Fall</p>]]></description></item><item><title>National health expenditures, 1978.</title><pubDate>Mon, 04 Nov 2019 02:26:55 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1190345</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1190345</guid><description><![CDATA[<p>abstract: Outlays for health care in the Nation reached $192.4 billion in calendar year 1978--13 percent higher than in 1977, according to preliminary figures compiled by the Health Care Financing Administration. This estimate represented $863 per person in the United States and was equal to 9.1 percent of the GNP. This latest report in the annual series representing national health expenditures provides detailed estimates of health care spending by type of service and method of financing. Revised estimates are presented extending back to 1965.</p><p>authors: N/A</p><p>issue_mesh: Economics, Hospital/trends : Financing, Organized/trends : Health Expenditures/trends : Insurance, Health/economics : Medicaid/economics : Medicare/economics : Personal Health Services/economics : Public Health Administration : Research Support : United States</p><p>issue_number: 1</p><p>ntis_number: PB81-112799</p><p>page_range: 1-36</p><p>primary_author: Gibson, Robert M</p><p>title: National health expenditures, 1978.</p><p>volume: 1</p><p>year_period: 1979 Summer</p>]]></description></item><item><title>Evaluating the predictive validity of nursing home pre-admission screens.</title><pubDate>Mon, 04 Nov 2019 02:26:55 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1190350</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1190350</guid><description><![CDATA[<p>abstract: This article demonstrates a method for evaluating the predictive validity of nursing home pre-admission screens (PAS) by using measures of predictive validity adapted from the field of epidemiology. Our approach estimates how well as PAS performs in identifying the "who but for" population of the Medicaid home and community-based services waiver programs for the frail elderly. The methodology's usefulness in screen revision is also illustrated.</p><p>authors: Eichorn, Ann; Sokoloff, Sharon; VanTassel, Janet</p><p>issue_mesh: Geriatric Assessment : Activities of Daily Living : Aged : Connecticut : Eligibility Determination/statistics &#x26; numerical data/standards : Epidemiologic Methods : Female : Forecasting : Frail Elderly : Homes for the Aged/economics/utilization : Human : Male : Medicaid/utilization : Nursing Homes/economics/utilization : Reproducibility of Results : Support, U.S. Gov't, Non-P.H.S. : United States</p><p>issue_number: 4</p><p>ntis_number: PB95-123485</p><p>page_range: 169-180</p><p>primary_author: Jackson, Mary E</p><p>title: Evaluating the predictive validity of nursing home pre-admission screens.</p><p>volume: 14</p><p>year_period: 1993 Summer</p>]]></description></item><item><title>Health care indicators.</title><pubDate>Mon, 04 Nov 2019 02:26:55 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191034</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191034</guid><description><![CDATA[<p>authors: Vanek, Anne E</p><p>issue_mesh: Data Collection : Economics/statistics &#x26; numerical data : Employment/statistics &#x26; numerical data : Health Services/economics : Hospitals, Community/statistics &#x26; numerical data : Inflation, Economic/statistics &#x26; numerical data : United States</p><p>issue_number: 3</p><p>ntis_number: PB89-208953</p><p>page_range: 125-145</p><p>primary_author: Donham, Carolyn S</p><p>title: Health care indicators.</p><p>volume: 10</p><p>year_period: 1989 Spring</p>]]></description></item><item><title>Access and satisfaction in the Arizona Health Care Cost Containment System.</title><pubDate>Mon, 04 Nov 2019 02:26:55 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191073</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191073</guid><description><![CDATA[<p>abstract: Results of a survey conducted in the summer of 1985 of beneficiaries of the Arizona Health Care Cost Containment System and a matched group of Medicaid beneficiaries concerning their access to and satisfaction with medical care services are described in this article. The Arizona Health Care Cost Containment System is an alternative to Medicaid's acute medical care coverage. The results of the study indicate few differences in access and satisfaction between the two groups of beneficiaries on access to care, reported use of services, or satisfaction with the care received.</p><p>authors: Jay, E Deborah; West, Richard</p><p>issue_mesh: Program Evaluation : Adolescence : Adult : Aged : Arizona : Consumer Satisfaction/statistics &#x26; numerical data : Data Collection : Female : Health Services Accessibility/statistics &#x26; numerical data : Human : Male : Medicaid/organization &#x26; administration : Middle Age : Pilot Projects : Rural Population : State Health Plans : United States : United States Health Care Financing Administration : Urban Population</p><p>issue_number: 1</p><p>ntis_number: PB90-146705</p><p>page_range: 63-77</p><p>primary_author: McCall, Nelda</p><p>title: Access and satisfaction in the Arizona Health Care Cost Containment System.</p><p>volume: 11</p><p>year_period: 1989 Fall</p>]]></description></item><item><title>Health services utilization and physician income trends.</title><pubDate>Mon, 04 Nov 2019 02:26:55 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191065</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191065</guid><description><![CDATA[<p>ntis_number: PB90-172255</p><p>page_range: 33-48</p><p>primary_author: Sandier, Simone</p><p>title: Health services utilization and physician income trends.</p><p>volume: Supp.</p><p>year_period: 1989 Supp.</p>]]></description></item><item><title>Overview of international comparisons of health care expenditures.</title><pubDate>Mon, 04 Nov 2019 02:26:55 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191062</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191062</guid><description><![CDATA[<p>ntis_number: PB90-172255</p><p>page_range: 1-7</p><p>primary_author: Schieber, George J</p><p>title: Overview of international comparisons of health care expenditures.</p><p>volume: Supp.</p><p>year_period: 1989 Supp.</p>]]></description></item><item><title>Using marginal analysis to evaluate health spending trends.</title><pubDate>Mon, 04 Nov 2019 02:26:55 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191024</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191024</guid><description><![CDATA[<p>abstract: In summary, the alternative methodology for measuring health spending trends compares the increment in health spending with the increment in the GNP as a measure of ability to pay. This method of analysis cannot solve the myriad of health cost problems, but it can help clarify the choices and judgments that society is implicitly making at the margin. By making these marginal allocation decisions more explicit, public and private decisionmakers can presumably make judgments that conform more closely to society's preferences, whether it be for more or less spending on health. This, in turn, should enhance the well-being of society.</p><p>authors: Freeland, Mark S; Levit, Katharine R</p><p>issue_mesh: Costs and Cost Analysis/statistics &#x26; numerical data : Economics, Hospital/statistics &#x26; numerical data : Financing, Organized/statistics &#x26; numerical data : Health Expenditures/statistics &#x26; numerical data : United States</p><p>issue_number: 2</p><p>ntis_number: PB89-188486</p><p>page_range: 123-129</p><p>primary_author: Kowalczyk, George I</p><p>title: Using marginal analysis to evaluate health spending trends.</p><p>volume: 10</p><p>year_period: 1988 Winter</p>]]></description></item><item><title>Medicare and Medicaid physician payment incentives.</title><pubDate>Mon, 04 Nov 2019 02:26:54 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191046</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191046</guid><description><![CDATA[<p>abstract: The incentives in the Medicare and Medicaid physician payment systems and their effects on six interrelated aspects of health care costs and beneficiary access to care were analyzed. Research results and data presented indicate that Medicare and Medicaid physician payment incentives are inconsistent with current public policy goals of (1) containing inflation in fees and expenditures, (2) encouraging physician participation in public programs, (3) improving the geographic and specialty distributions of physicians, (4) encouraging primary care instead of surgery, and also outpatient rather than inpatient treatment.</p><p>authors: Blaxall, Martha O; Gabel, Jon R; Schieber, George J</p><p>issue_mesh: Health Services Accessibility : Ambulatory Care/economics : Cost Control : Fees, Medical : Inflation, Economic : Insurance, Physician Services/economics : Medicaid/economics : Medicare/economics : Physicians/supply &#x26; distribution : Reimbursement Mechanisms/economics : Reimbursement, Incentive/economics : United States</p><p>issue_number: 1</p><p>ntis_number: PB81-112799</p><p>page_range: 62-78</p><p>primary_author: Burney, Ira L</p><p>title: Medicare and Medicaid physician payment incentives.</p><p>volume: 1</p><p>year_period: 1979 Summer</p>]]></description></item><item><title>How recalibration method, pricing, and coding affect DRG weights.</title><pubDate>Mon, 04 Nov 2019 02:26:54 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1190349</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1190349</guid><description><![CDATA[<p>abstract: We compared diagnosis-related group (DRG) weights calculated using the hospital-specific relative-value (HSRV) methodology with those calculated using the standard methodology for each year from 1985 through 1989 and analyzed differences between the two methods in detail for 1989. We provide evidence suggesting that classification error and subsidies of higher weighted cases by lower weighted cases caused compression in the weights used for payment as late as the fifth year of the prospective payment system. However, later weights calculated by the standard method are not compressed because a statistical correlation between high markups and high case-mix indexes offsets the cross-subsidization. HSRV weights from the same files are compressed because this methodology is more sensitive to cross-subsidies. However, both sets of weights produce equally good estimates of hospital-level costs net of those expenses that are paid by outlier payments. The greater compression of the HSRV weights is counterbalanced by the fact that more high-weight cases qualify as outliers.</p><p>authors: Rogowski, Jeannette R</p><p>issue_mesh: Relative Value Scales : Comparative Study : Costs and Cost Analysis/statistics &#x26; numerical data : Diagnosis-Related Groups/classification/economics : Economics, Hospital/statistics &#x26; numerical data : Fees and Charges/statistics &#x26; numerical data : Longitudinal Studies : Medical Records/classification : Medicare/economics/statistics &#x26; numerical data : Prospective Payment System/economics : Regression Analysis : Support, Non-U.S. Gov't : Support, U.S. Gov't, Non-P.H.S. : United States</p><p>issue_number: 2</p><p>ntis_number: PB2001-105739</p><p>page_range: 83-96</p><p>primary_author: Carter, Grace M</p><p>title: How recalibration method, pricing, and coding affect DRG weights.</p><p>volume: 14</p><p>year_period: 1992 Winter</p>]]></description></item><item><title>National health expenditures, 1995.</title><pubDate>Mon, 04 Nov 2019 02:26:54 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1190353</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1190353</guid><description><![CDATA[<p>abstract: This article presents data on health care spending for the United States, covering expenditures for various types of medical services and products and their sources of funding from 1960 to 1995. In 1995, $988.5 billion was spent to purchase health care in the United States, up 5.5 percent from 1994. Growth in spending between 1993 and 1995 was the slowest in more than three decades, primarily because of slow growth in private health insurance and out-of-pocket spending. As a result, the share of health spending funded by private sources fell, reflecting the influence of increased enrollment in managed care plans.</p><p>authors: Braden, Bradley R; Cowan, Cathy A; Donham, Carolyn S; Lazenby, Helen C; Long, Anna M; McDonnell, Patricia A; Sivarajan, Lekha; Stewart, Madie W; Stiller, Jean M; Won, Darleen K</p><p>issue_mesh: Advertising : Cost Sharing : Drug Industry/economics : Fees, Medical/statistics &#x26; numerical data : Health Expenditures/classification/statistics &#x26; numerical data/trends : Home Care Services/economics/statistics &#x26; numerical data : Hospitalization/economics/statistics &#x26; numerical data : Long-Term Care/economics/statistics &#x26; numerical data/utilization : Managed Care Programs/economics/statistics &#x26; numerical data : Medicaid/statistics &#x26; numerical data/utilization : Medicare/statistics &#x26; numerical data/utilization : Nursing Homes/economics/statistics &#x26; numerical data/utilization : Prescriptions, Drug/economics/statistics &#x26; numerical data : United States</p><p>issue_number: 1</p><p>ntis_number: PB99-106494</p><p>page_range: 175-214</p><p>primary_author: Levit, Katharine R</p><p>title: National health expenditures, 1995.</p><p>volume: 18</p><p>year_period: 1996 Fall</p>]]></description></item><item><title>A study of the "crossover population": aged persons entitled to both Medicare and Medicaid.</title><pubDate>Mon, 04 Nov 2019 02:26:54 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1190361</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1190361</guid><description><![CDATA[<p>abstract: This study focused on persons 65 years of age and over who were dually entitled to Medicare and Medicaid in 1978. The paper examines their age, sex, and race characteristics, and their Medicare utilization and mortality rates in comparison to persons eligible for Medicare only. The study showed that the group entitled to both Medicare and Medicaid was relatively much older than those with Medicare only, with a mean age of 76.6 years compared to 73.6 years. In the group entitled to both Medicare and Medicaid, the proportion of persons of minority races was four times as great as the proportion in the remaining population. Nevertheless, nearly three out of four persons entitled to both programs were white. In the group with dual eligibility, 71 percent were women, compared to only 59 percent in the Medicare-only population. Thus, the dually covered group may be characterized as being relatively older than other Medicare enrollees, largely composed of white persons and women, and as having a higher proportion of minority persons than the general population. The study showed that a much higher proportion of dually entitled persons were users of the Medicare program than were persons eligible for Medicare only. On a per-enrollee basis, reimbursement was substantially higher for those dually eligible. The study also found differences in the diagnostic conditions of the dually entitled. The data indicate (after being standardized for age) that the death rate was 50 percent higher for the dually entitled. This difference in mortality is partly attributable to the relatively high mortality rates for the medically needy; nonetheless, the mortality rate for the dually entitled who also received cash assistance was 20 percent higher than those for other Medicare enrollees. The excess mortality among this group was notably higher for the age group 65-69, with a 50 percent excess mortality, and for the age group 70-79, the excess mortality was 30 percent. Thus, the dually entitled, in general, experience higher mortality rates than those with Medicare only, and that fact very likely explains to a large extent the higher utilization rates found for the dually entitled in this study. The paper concludes by raising some possible consequences of either Medicare or Medicaid coverage being altered or tightened.</p><p>authors: Gornick, Marian; Pine, Penelope L; Prihoda, Ronald</p><p>issue_mesh: Aged : Female : Human : Male : Medicaid/utilization : Medicare/utilization : Minority Groups : Mortality : Population : Poverty : United States</p><p>issue_number: 4</p><p>ntis_number: PB83-220657</p><p>page_range: 19-46</p><p>primary_author: McMillan, Alma</p><p>title: A study of the "crossover population": aged persons entitled to both Medicare and Medicaid.</p><p>volume: 4</p><p>year_period: 1983 Summer</p>]]></description></item><item><title>Consumer perspectives on information needs for health plan choice.</title><pubDate>Mon, 04 Nov 2019 02:26:54 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1190352</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1190352</guid><description><![CDATA[<p>abstract: The premise that competition will improve health care assumes that consumers will choose plans that best fit their needs and resources. However, many consumers are frustrated with currently available plan comparison information. We describe results from 22 focus groups in which Medicare beneficiaries, Medicaid enrollees, and privately insured consumers assessed the usefulness of indicators based on consumer survey data and Health Employer Data Information Set (HEDIS)-type measures of quality of care. Considerable education would be required before consumers could interpret report card data to inform plan choices. Policy implications for design and provision of plan information for Medicare beneficiaries and Medicaid enrollees are discussed.</p><p>authors: Burrus, Barri; Sangl, Judith A</p><p>issue_mesh: Consumer Participation : Competitive Medical Plans/standards : Consumer Satisfaction : Data Collection : Health Benefit Plans, Employee/standards : Health Services Research : Information Services/standards/utilization : Medicaid : Medicare : Quality of Health Care/classification : Support, U.S. Gov't, Non-P.H.S. : United States</p><p>issue_number: 1</p><p>ntis_number: PB99-106494</p><p>page_range: 55-73</p><p>primary_author: Gibbs, Deborah A</p><p>title: Consumer perspectives on information needs for health plan choice.</p><p>volume: 18</p><p>year_period: 1996 Fall</p>]]></description></item><item><title>Racial and Ethnic Disparities in Prescription Coverage and Medication Use</title><pubDate>Mon, 04 Nov 2019 02:26:54 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1190356</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1190356</guid><description><![CDATA[<p>page_range: 63-76</p><p>primary_author: Briesacher, Becky</p><p>title: Racial and Ethnic Disparities in Prescription Coverage and Medication Use</p><p>volume: 25</p><p>year_period: 2003 Winter</p>]]></description></item><item><title>Medicare second surgical opinion programs: the effect of waiving cost-sharing.</title><pubDate>Mon, 04 Nov 2019 02:26:54 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1190360</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1190360</guid><description><![CDATA[<p>authors: N/A</p><p>issue_mesh: Deductibles and Coinsurance/legislation &#x26; jurisprudence : Medicare/utilization : Referral and Consultation/economics : Surgical Procedures, Operative/economics : United States</p><p>issue_number: 1</p><p>ntis_number: PB83-104414</p><p>page_range: 99-106</p><p>primary_author: Friedlob, Alan S</p><p>title: Medicare second surgical opinion programs: the effect of waiving cost-sharing.</p><p>volume: 4</p><p>year_period: 1982 Sep</p>]]></description></item><item><title>Community hospital statistics.</title><pubDate>Mon, 04 Nov 2019 02:26:54 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191044</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191044</guid><description><![CDATA[<p>authors: Maple, Brenda T</p><p>issue_mesh: Costs and Cost Analysis/trends : Data Collection : Employment/statistics &#x26; numerical data : Fees and Charges/trends : Home Care Services/economics : Hospitals, Community/statistics &#x26; numerical data : Income : Inflation, Economic/trends : Personnel Staffing and Scheduling/trends : Salaries and Fringe Benefits/trends : Skilled Nursing Facilities/economics : United States</p><p>issue_number: 4</p><p>ntis_number: PB89-232342</p><p>page_range: 121-140</p><p>primary_author: Donham, Carolyn S</p><p>title: Community hospital statistics.</p><p>volume: 10</p><p>year_period: 1989 Summer</p>]]></description></item><item><title>Reflections on the enactment of Medicare and Medicaid.</title><pubDate>Mon, 04 Nov 2019 02:26:54 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1190363</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1190363</guid><description><![CDATA[<p>ntis_number: PB86-156551</p><p>page_range: 3-11</p><p>primary_author: Cohen, Wilbur J</p><p>title: Reflections on the enactment of Medicare and Medicaid.</p><p>volume: Supp.</p><p>year_period: 1985 Supp.</p>]]></description></item><item><title>Acute physiology and chronic health evaluation (APACHE II) and Medicare reimbursement.</title><pubDate>Mon, 04 Nov 2019 02:26:54 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1190362</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1190362</guid><description><![CDATA[<p>ntis_number: PB85-155083</p><p>page_range: 91-105</p><p>primary_author: Wagner, Douglas P</p><p>title: Acute physiology and chronic health evaluation (APACHE II) and Medicare reimbursement.</p><p>volume: Supp.</p><p>year_period: 1984 Supp.</p>]]></description></item><item><title>Analysis of services received under Medicare by specialty of physician.</title><pubDate>Mon, 04 Nov 2019 02:26:54 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1190249</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1190249</guid><description><![CDATA[<p>abstract: This paper examines use of physicians' services by Medicare beneficiaries according to the specialty of the physician providing care. The major objectives of this study were to determine which types of physicians are most frequently used, the average charge per service by specialty, the mix of physicians (by specialty) that patients saw during the year, and the amount Medicare reimburses in relation to total physician income. Data were studied for the total Medicare population and by age, sex, race, and geographic area. Claims data for 1975 and 1977 were used from the Part B Bill Summary System. This system collects information from bills from a 5 percent sample of Medicare enrollees. Major findings from this study indicate: (1) Physicians in general practice and internal medicine provided about the same number of services and each far outranked all other types of physicians in numbers of Medicare beneficiaries with reimbursed services. (2) There were marked differences by census region in the use of certain specialists, particularly pathologists, podiatrists, dermatologists, and the specialty group otology, laryngology, rhinology. (3) Average charges per service varied considerably by specialty. Internists' charges averaged 35 percent higher per service than charges by general practitioners. Charges submitted by the surgical specialties far outranked all others and showed the greatest increase during the period under study. (4) Of the total persons with reimbursement physicians' services in 1977, 85 percent saw a primary care physician during the year, while the remaining 15 percent received services from specialists only. (5) Of the total reimbursements made by Medicare, internists received 20 percent, general practitioners received 14 percent, and general surgeons 12 percent. Medicare's payments were estimated to be 21 percent of total gross income for internists, 20 percent for anesthesiologists, and 18 percent for surgical specialties.</p><p>authors: Gornick, Marian; Lubitz, James; Newton, Marilyn</p><p>issue_mesh: Insurance, Health, Reimbursement : Insurance, Physician Services/economics : Medicare/utilization : Specialties, Medical/economics : United States</p><p>issue_number: 1</p><p>ntis_number: PB82-130170</p><p>page_range: 89-116</p><p>primary_author: Pine, Penelope L</p><p>title: Analysis of services received under Medicare by specialty of physician.</p><p>volume: 3</p><p>year_period: 1981 Sep</p>]]></description></item><item><title>Cost effectiveness of home and community-based care.</title><pubDate>Mon, 04 Nov 2019 02:26:54 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191040</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191040</guid><description><![CDATA[<p>abstract: Medicaid section 2176 waivers allow States to provide home and community-based care to Medicaid eligibles who, but for these services, would enter Medicaid-funded nursing homes. One of the conditions required by Congress for granting these waivers is that this substitution results in no additional Medicaid spending (budget neutrality). The results of case studies of two of these waiver programs, one in California and one in Georgia, are presented in this article. The case studies contain a description of the operation of these programs in some detail. Next, the data and techniques needed to assess the ability of these programs to achieve budget neutrality are presented, and the performance of these programs along this dimension is evaluated.</p><p>authors: Adler, Gerald S; Manton, Kenneth G</p><p>issue_mesh: Activities of Daily Living : Actuarial Analysis : Aged : California : Community Health Services/economics : Comparative Study : Costs and Cost Analysis : Female : Georgia : Home Care Services/economics : Human : Institutionalization/economics : Male : Medicaid/organization &#x26; administration : Models, Statistical : Nursing Homes/utilization : Reimbursement Mechanisms : Support, U.S. Gov't, Non-P.H.S. : United States</p><p>issue_number: 4</p><p>ntis_number: PB89-232342</p><p>page_range: 65-78</p><p>primary_author: Vertrees, James C</p><p>title: Cost effectiveness of home and community-based care.</p><p>volume: 10</p><p>year_period: 1989 Summer</p>]]></description></item><item><title>Longitudinal patterns of enrollment and expenditures for a Medicaid cohort.</title><pubDate>Mon, 04 Nov 2019 02:26:54 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1190343</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1190343</guid><description><![CDATA[<p>abstract: This article is based on 4 years of data for a cohort of Medicaid enrollees in California and Georgia to determine patterns of enrollment and expenditures. The analyses were developed from the statistical system known as Tape-to-Tape, which is based on Medicaid enrollment and claims files from these and other States. The composition of the cohort changed over times as a result of the differential rates of turnover for subgroups of the Medicaid population. Longitudinal expenditure patterns also varied by health service and eligibility group. These Medicaid expenditure patterns differed from those observed previously in Medicare studies, undoubtedly reflecting differences in service coverage under Medicare and Medicaid.</p><p>authors: Andrews, Roxanne M; Gornick, Marian</p><p>issue_mesh: Adult : Aged : Aid to Families with Dependent Children/utilization : California : Child : Cohort Studies : Georgia : Health Expenditures/statistics &#x26; numerical data : Human : Longitudinal Studies : Medicaid/utilization : Models, Statistical</p><p>issue_number: 1</p><p>ntis_number: PB89-188478</p><p>page_range: 71-85</p><p>primary_author: Howell, Embry M</p><p>title: Longitudinal patterns of enrollment and expenditures for a Medicaid cohort.</p><p>volume: 10</p><p>year_period: 1988 Fall</p>]]></description></item><item><title>Reimbursement of sole community hospitals under Medicare's prospective payment system.</title><pubDate>Mon, 04 Nov 2019 02:26:53 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1190366</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1190366</guid><description><![CDATA[<p>abstract: Under the prospective payment system (PPS), designated sole community hospitals (SCH's), usually smaller than other rural hospitals but offering comparable services, have had higher average cost levels, in part because of underutilization of plant and equipment. This has resulted in negative operating margins on patient revenues, although local financial support and other revenue sources bring margins on total revenues into the positive range. The PPS legislation has also provided SCH's temporary protection from volume declines. SCH's are more likely than other rural hospitals to experience large volume swings, but only for declines greater than the threshold specified under PPS.</p><p>authors: Cromwell, Jerry L</p><p>issue_mesh: Bed Occupancy : Catchment Area (Health) : Data Collection : Hospital Departments/economics : Hospitals, Community/economics : Medicare : Ownership : Patient Admission/trends : Population Dynamics : Prospective Payment System/methods : Statistics : United States : United States Health Care Financing Administration</p><p>issue_number: 2</p><p>ntis_number: PB88-196670</p><p>page_range: 39-54</p><p>primary_author: Freiman, Marc P</p><p>title: Reimbursement of sole community hospitals under Medicare's prospective payment system.</p><p>volume: 9</p><p>year_period: 1987 Winter</p>]]></description></item><item><title>National Health Expenditures, 2002</title><pubDate>Mon, 04 Nov 2019 02:26:53 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1190357</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1190357</guid><description><![CDATA[<p>page_range: 143-166</p><p>primary_author: Cowan, Cathy</p><p>title: National Health Expenditures, 2002</p><p>volume: 25</p><p>year_period: 2004 Summer</p>]]></description></item><item><title>Analysis of services received under Medicare by specialty of physician.</title><pubDate>Mon, 04 Nov 2019 02:26:53 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1190359</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1190359</guid><description><![CDATA[<p>abstract: This paper examines use of physicians' services by Medicare beneficiaries according to the specialty of the physician providing care. The major objectives of this study were to determine which types of physicians are most frequently used, the average charge per service by specialty, the mix of physicians (by specialty) that patients saw during the year, and the amount Medicare reimburses in relation to total physician income. Data were studied for the total Medicare population and by age, sex, race, and geographic area. Claims data for 1975 and 1977 were used from the Part B Bill Summary System. This system collects information from bills from a 5 percent sample of Medicare enrollees. Major findings from this study indicate: (1) Physicians in general practice and internal medicine provided about the same number of services and each far outranked all other types of physicians in numbers of Medicare beneficiaries with reimbursed services. (2) There were marked differences by census region in the use of certain specialists, particularly pathologists, podiatrists, dermatologists, and the specialty group otology, laryngology, rhinology. (3) Average charges per service varied considerably by specialty. Internists' charges averaged 35 percent higher per service than charges by general practitioners. Charges submitted by the surgical specialties far outranked all others and showed the greatest increase during the period under study. (4) Of the total persons with reimbursement physicians' services in 1977, 85 percent saw a primary care physician during the year, while the remaining 15 percent received services from specialists only. (5) Of the total reimbursements made by Medicare, internists received 20 percent, general practitioners received 14 percent, and general surgeons 12 percent. Medicare's payments were estimated to be 21 percent of total gross income for internists, 20 percent for anesthesiologists, and 18 percent for surgical specialties.</p><p>authors: Gornick, Marian; Lubitz, James; Newton, Marilyn</p><p>issue_mesh: Insurance, Health, Reimbursement : Insurance, Physician Services/economics : Medicare/utilization : Specialties, Medical/economics : United States</p><p>issue_number: 1</p><p>ntis_number: PB82-130170</p><p>page_range: 89-116</p><p>primary_author: Pine, Penelope L</p><p>title: Analysis of services received under Medicare by specialty of physician.</p><p>volume: 3</p><p>year_period: 1981 Sep</p>]]></description></item><item><title>Comparing case-mix systems for nursing home payment.</title><pubDate>Mon, 04 Nov 2019 02:26:53 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1190347</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1190347</guid><description><![CDATA[<p>abstract: Case-mix systems for nursing homes use resident characteristics to predict the relative use of resources. Seven systems are compared in structure, accuracy in explaining resource use, group homogeneity, and ability to identify residents receiving heavy care. Resource utilization groups, version II (RUG-II), was almost uniformly the best system, although management minutes and the Minnesota case-mix system were also highly effective. Relative weights for case-mix groups were sensitive to cost differences and should be recomputed for new applications. Multiple criteria should be used in choosing a case-mix system, including consideration of inherent incentives and how residents' characteristics are defined.</p><p>authors: N/A</p><p>issue_mesh: Diagnosis-Related Groups : Comparative Study : Evaluation Studies : Health Resources/supply &#x26; distribution : Long-Term Care/classification : Models, Theoretical : Nursing Homes/utilization : Statistics : United States</p><p>issue_number: 4</p><p>ntis_number: PB91-105973</p><p>page_range: 103-119</p><p>primary_author: Fries, Brant E</p><p>title: Comparing case-mix systems for nursing home payment.</p><p>volume: 11</p><p>year_period: 1990 Summer</p>]]></description></item><item><title>Health spending and ability to pay: business, individuals, and government.</title><pubDate>Mon, 04 Nov 2019 02:26:53 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1190344</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1190344</guid><description><![CDATA[<p>abstract: Health care spending has grown almost twice as fast as has the gross national product since 1965. Various parties in the health care financing arena have been affected to different degrees by this rising health care spending. As discussed in this article, households, businesses, and government all have had to devote increasing shares of their resources to financing health care. Although businesses have been increasingly burdened, either directly or through higher insurance premiums and Medicare taxes, that burden is less than is popularly believed.</p><p>authors: Freeland, Mark S; Waldo, Daniel R</p><p>issue_mesh: Data Collection : Financing, Organized/statistics &#x26; numerical data : Government : Health Expenditures/statistics &#x26; numerical data : Income : United States</p><p>issue_number: 3</p><p>ntis_number: PB89-208953</p><p>page_range: 1-12</p><p>primary_author: Levit, Katharine R</p><p>title: Health spending and ability to pay: business, individuals, and government.</p><p>volume: 10</p><p>year_period: 1989 Spring</p>]]></description></item><item><title>Commentary on some studies on the quality of care.</title><pubDate>Mon, 04 Nov 2019 02:26:53 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1190365</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1190365</guid><description><![CDATA[<p>ntis_number: PB89-136956</p><p>page_range: 75-85</p><p>primary_author: Donabedian, Avedis</p><p>title: Commentary on some studies on the quality of care.</p><p>volume: Supp.</p><p>year_period: 1987 Supp.</p>]]></description></item><item><title>HCFA's racial and ethnic data: Current accuracy and recent improvements</title><pubDate>Mon, 04 Nov 2019 02:26:53 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1190355</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1190355</guid><description><![CDATA[<p>page_range: 107-127</p><p>primary_author: Arday, Susan L</p><p>title: HCFA's racial and ethnic data: Current accuracy and recent improvements</p><p>volume: 21</p><p>year_period: 2000 Summer</p>]]></description></item><item><title>Trends in hospital labor and total factor productivity, 1981-86.</title><pubDate>Mon, 04 Nov 2019 02:26:53 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191038</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1191038</guid><description><![CDATA[<p>abstract: The per-case payment rates of Medicare's prospective payment system are annually updated. As one element of the update factor, Congress required consideration of changes in hospital productivity. In this article, calculations of annual changes in labor and total factor productivity during 1981-86 of hospitals eligible for prospective payment are presented using several output and input variants. Generally, productivity has declined since 1980, although the rates of decline have slowed since prospective payment implementation. According to the series of analyses most relevant for policy, significant hospital productivity gains occurred during 1983-86. This may justify a lower update factor.</p><p>authors: Pope, Gregory C</p><p>issue_mesh: Efficiency : Models, Statistical : Costs and Cost Analysis/trends : Economics, Hospital/statistics &#x26; numerical data : Fees and Charges/trends : Medicare/economics : Personnel Staffing and Scheduling/trends : Prospective Payment System/methods : Support, U.S. Gov't, Non-P.H.S. : United States</p><p>issue_number: 4</p><p>ntis_number: PB89-232342</p><p>page_range: 39-50</p><p>primary_author: Cromwell, Jerry L</p><p>title: Trends in hospital labor and total factor productivity, 1981-86.</p><p>volume: 10</p><p>year_period: 1989 Summer</p>]]></description></item><item><title>Minority health status in adulthood: The middle years of life</title><pubDate>Mon, 04 Nov 2019 02:26:53 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1190354</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1190354</guid><description><![CDATA[<p>page_range: 9-21</p><p>primary_author: LaVeist, Thomas A</p><p>title: Minority health status in adulthood: The middle years of life</p><p>volume: 21</p><p>year_period: 2000 Summer</p>]]></description></item><item><title>Loss of Medicaid and access to health services.</title><pubDate>Mon, 04 Nov 2019 02:26:52 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1190348</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1190348</guid><description><![CDATA[<p>abstract: In this article, the authors assessed the effects of the loss of Medicaid eligibility on access to health services by the medically indigent population in two California counties. An historically derived baseline of health services received by each county's medically indigent adults under Medicaid was compared with the volume of services provided by the county to the same population after they lost Medicaid eligibility. The baseline figures were used as an "expected" volume of services which can be compared with the actual, or "observed," volume of services. The analysis found fewer hospital discharges than expected in Los Angeles and much fewer outpatient visits than expected in Orange County, suggesting that these groups experienced substantial reductions in access related to loss of Medicaid eligibility.</p><p>authors: Cousineau, Michael R</p><p>issue_mesh: Public Health Administration : Ambulatory Care/utilization : California : Community Health Services/utilization : Eligibility Determination/trends : Government : Health Services Accessibility/economics : Hospitalization/statistics &#x26; numerical data : Hospitals, County/utilization : Medicaid/organization &#x26; administration : Medical Indigency/statistics &#x26; numerical data : Poverty/statistics &#x26; numerical data : United States</p><p>issue_number: 4</p><p>ntis_number: PB2001-105731</p><p>page_range: 17-26</p><p>primary_author: Brown, E Richard</p><p>title: Loss of Medicaid and access to health services.</p><p>volume: 12</p><p>year_period: 1991 Summer</p>]]></description></item><item><title>Physicians' charges under Medicare: assignment rates and beneficiary liability.</title><pubDate>Mon, 04 Nov 2019 02:26:52 -0500</pubDate><link>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1190346</link><guid>https://www.cms.gov//research-statistics-data-and-systems/research/healthcarefinancingreview/list-of-past-articles-items/cms1190346</guid><description><![CDATA[<p>abstract: Under Medicare's Part B program, the physician decides whether to accept assignment of claims. When assignment is accepted, the physician agrees to accept as full payment Medicare's allowed charge. Physicians' acceptance of assignment is of considerable importance in relieving the beneficiaries of the burden of the costs of medical care services. This factor and the beneficiaries' liabilities for premiums, the annual deductible, and coinsurance are analyzed in considerable detail in this report. Data from physicians' claims for services in 1975 show that 45.8 percent of the services and 47.2 percent of the charges were assigned for the aged. There were wide variations in the rate of acceptance of assignment by physician specialty, and by age, race, and residence of beneficiaries. Total beneficiary liability from the deductible, coinsurance, and from unassigned claims amounted to 37.7 percent of total physicians' charges due. When the premium which the beneficiary pays for Part B is included, beneficiary liability rises to 69.2 percent of total physicians' charges due.</p><p>authors: Gornick, Marian; Hackerman, Carl; Newton, Marilyn</p><p>issue_mesh: Fees, Medical : Insurance, Health : Insurance, Health, Reimbursement : Aged : Human : Medicare/economics : Patient Credit and Collection : United States</p><p>issue_number: 3</p><p>ntis_number: PB81-112831</p><p>page_range: 49-73</p><p>primary_author: Ferry, Thomas P</p><p>title: Physicians' charges under Medicare: assignment rates and beneficiary liability.</p><p>volume: 1</p><p>year_period: 1980 Winter</p>]]></description></item></channel></rss>
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