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ISSUES IN SCIENCE AND TECHNOLOGY 1991年第4期7卷 56-62页

作者： COYE, MJ JOHNS HOPKINS UNIV SCH PUBL HLTH BALTIMORE MD 21218 USA

Innovative state programs and possibilities for an effective national program. Uncompensated-care systems, Medicaid expansion, state subsidies for private insurance, and employer-mandated health insurance.

关键词：保健福利计划雇员/组织和管理卫生服务研究保险住院/组织和管理 Medicaid/组织和管理医疗费用无力承担/经济学贫困社会问题州卫生计划/经济学美国美国卫生和人类服务部

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Medicaid, managed care, and the care of patients hospitalized for acute myocardial infarction

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AMERICAN HEART JOURNAL 2000年第4期139卷 567-576页

作者： Sloan, FA Rankin, PJ Whellan, DJ Conover, CJ Duke Univ Ctr Hlth Policy Law & Management Durham NC 27708 USA Duke Univ Dept Econ Durham NC 27708 USA Duke Univ Dept Med Div Cardiol Durham NC 27708 USA Charles Rivers Associates Durham NC USA

Background TennCare, beginning in January 1994, channeled all Medicaid-eligible patients into managed core while expanding Medicaid coverage to large numbers of previously uninsured patients. We assessed the impact of TennCare on (1) coronary revascularization of patients who had had an acute myocardial infarction (AMI), (2) the likelihood of the patient having a usual provider of care after discharge from the hospital, and (3) health and functional status 1 to 3 years after the index AMI. Methods and Results with the use of 1996 to 1997 survey data from 438 patients hospitalized for AMI in 1993 and 1995 who were under age 65 years at the index admission, multivariate analysis was used to calculate effects of TennCare on utilization and outcomes. TennCare patients were as likely as privately insured patients to have received coronary revascularization within 30 days of the index AMI (odds ratio 0.87, P = .69). Persons enrolled in TennCare and in traditional Medicaid who received a revascularization procedure were much less likely to have received coronary angioplasty than coronary bypass surgery than were the privately insured (TennCare: odds ratio 0.37, P = .05;Medicaid: odds ratio 0.28, P = .08). Virtually all TennCare enrollees (94%) reported having a usual provider of care in the year before the survey versus 85% for privately insured patients with AMI in 1995 (P = .05). On health and functional status, TennCare enrollees overall fared as well as those with private insurance. Conclusions Our results suggest that TennCare brought patients who otherwise would have been uninsured or enrolled in Medicaid into the medical mainstream, measured both in terms of utilization of services and health and functional status.

关键词：费用控制/发展趋势住院/经济学住院时间/经济学管理医疗规划/经济学 Medicaid/经济学心肌梗死/经济学心肌梗死/死亡率心肌梗死/治疗心肌血管重建术/经济学结果与过程评价(卫生保健)/经济学州卫生计划/经济学田纳西美国利用情况审核/经济学成年人女(雌)性人类男(雄)性中年人

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The share of Medicaid for nursing home care.

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Journal of health & social policy 1990年第3期1卷 35-53页

作者： Swan, J.H. Institute for Health and Aging University of California San Francisco 94143.

Over one-third of Medicaid dollars go to nursing homes, a share that is decreasing but that varies widely among the states. This paper examines demand, supply, and policy factors explaining interstate variation over time in the nursing home share of state Medicaid dollars. Nursing home bed stock shows strong effects;Medicaid expenditures for acute hospital and for ICF-MR care are important;and various demand factors also explain nursing home share. In this model, residual nursing home share of Medicaid declines over time, which is interpreted to reflect omitted state policy factors explaining state ability to constrain Medicaid nursing home utilization and expenditures.

关键词：卫生经费支出/统计学和数值数据医院病床数中间诊疗设施/经济学 Medicaid/统计学和数值数据精神发育迟滞/经济学回归分析技术性护理设施/经济学州卫生计划/经济学美国人类

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A study of physician reactions to the Medicare cost containment pilot program in the state of Georgia

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Journal of Hospital Marketing 1996年第2期10卷 61-76页

作者： Mobley, M.C. Mobley, M.F. School of Business Administration Augusta College Augusta GA 30904 United States

Having reduced the unit cost of physician fees during the 1980s, the federal government set up a Medicare pilot study in the state of Georgia in 1989 to test the impact of its cost containment strategies aimed at reducing volume of services. This research has attempted not only to clarify the nature of physician reaction to the Medicare pilot study and to quantify the level of the dissatisfaction, but also to provide a richer understanding of the dynamic meaning of the dissatisfaction that Georgia physicians feel.

关键词：医务工作者的态度 Medicare与Medicaid服务中心(美国) 费用控制/立法和法学人口统计学佐治亚保险索赔审核 Medicare/立法和法学组织目标医师/心理学医师/统计学和数值数据试点项目州卫生计划/经济学美国老年人人类

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NO-FAULT MEDICAL LIABILITY IN VIRGINIA AND FLORIDA - A PRELIMINARY EVALUATION

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EVALUATION & THE HEALTH PROFESSIONS 1995年第2期18卷 137-151页

作者： PATEL, K SW MISSOURI STATE UNIV SPRINGFIELDMO 65804 USA

State governments are experimenting with a variety of innovative approaches to the current fort system for medical malpractice liability. One such approach is to apply the concept of no-fault liability to medical practice. States such as Virginia and Florida have already adopted a limited version of such a concept. This article examines the problems of the current tort system, different types of no-fault medical insurance alternatives and their advantages, and the experiences of the states of Virginia and Florida with their limited no-fault malpractice insurance systems. The author concludes that the concept of no-fault compensation for medical malpractice is a promising remedy. However, it is a medicine that will require more testing before it can be pronounced a cure for the disease that plagues the current system.

关键词：产伤/经济学佛罗里达保险责任/立法和法学责任法律医疗事故/经济学医疗事故/立法和法学组织改革方案评价州卫生计划/经济学州卫生计划/立法和法学美国弗吉尼亚人类婴儿新生

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Consequences of alternative programs to cover the uninsured in central southern states

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Journal of Health and Social Policy 1993年第1期5卷 33-42页

作者： Capilouto, E. Dailey, T.E. UniversityofAlabamaSchoolofPublicHealth ListerHillCenterforHealthPolicy.

The lack of health insurance represents a significant barrier to timely, preventive medical services. In addition, certain providers risk financial viability as their uncompensated care burdens worsen These issues are particularly troublesome in southern states because the population is disproportionately represented by greater numbers of poor uninsured individuals. This study examines the consequences of three alternative proposals to reduce the number of uninsureds in five southern states. Program 1 raises the AFDC income eligibility threshold to the federal poverty level. Program 2 drops Medicaid categorical eligibility requirements in favor of a poverty-level income standard. Program 3 requires employers to insure all employees, and their dependents, who work 25 hours or more per week. Surprisingly, Program 1 produces a modest 16 percent reduction in the uninsured. Programs 2 and 3, however, reduce the uninsured population by 41 and 57 percent, respectively. Nonetheless, these last two programs reach very different income groups. Program 2 captures all the poor uninsureds whereas Program 3 includes 40 percent of this same population. From this analysis it is clear that a combination of these programs would be necessary to effectively cover the uninsured.

关键词：卫生服务研究 Medicaid/立法和法学 Medicaid/组织和管理未参加医疗保险者方案评价/统计学和数值数据社会经济因素美国东南部州卫生计划/经济学美国

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Behavioral health funding for native Americans in Arizona: Policy implications for states and tribes

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JOURNAL OF BEHAVIORAL HEALTH SERVICES & RESEARCH 2000年第1期27卷 17-28页

作者： Provan, KG Carson, LMP Univ Arizona Sch Publ Adm & Policy Tucson AZ 85721 USA Univ Arizona Arizona Prevent Ctr Tucson AZ 85721 USA

This article examines the principal structures and mechanisms used by federal and state government to fund the behavioral health needs of Native American Indians. Using Arizona as a case study, the article provides an overview of both federal and state programs, especially Medicaid, discussing the problems and strengths of each. The article concludes with a discussion of the policy implications of these programs for both states and tribes,focusing on issues concerning administrative complexity, tribal sovereignty, improving behavioral health services, and assignment of financial risk.

关键词：筹资政府卫生政策印第安人北美洲 Medicaid/经济学精神卫生服务/经济学州卫生计划/经济学美国美国印第安人卫生处/经济学美国印第安人卫生处/立法和法学人类

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Results of the assessment of kentucky's medicaid home- and community-based services waiver

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Home Health Care Services Quarterly 1991年第3期12卷 33-57页

作者： Beaulieu, Joyce E. Health Administration and Public Administration Associate Sanders-Brown Center on Aging University of Kentucky Lexington KY 40536-0080 United States

In states where a Home- and Community-based Services Waiver is operating under the Medicaid program, HCFA requires an independent assessment of the program. This paper reports on two assessments of the costs and use of services under Kentucky's HCBS waiver;one comparing waiver clients to a matched control group of regular Medicaid home health clients, and the other comparing elderly female waiver clients to a matched control group from nursing homes. Analyses of costs and use of home health services, hospital care, physician services, nursing home admission, and other services showed little difference between waiver clients and control groups. Waiver clients used more home health, but used other services at the same rate. Their costs were lower overall. © 1991 Taylor & Francis Group, LLC.

关键词：卡方分布费用效益分析/方法数据收集卫生服务研究/方法家庭医疗保健服务/经济学家庭医疗保健服务/统计学和数值数据家庭医疗保健服务/利用肯塔基 Medicaid/统计学和数值数据 Medicaid/利用医护疗养所/经济学医护疗养所/统计学和数值数据医护疗养所/利用方案评价/方法研究设计州卫生计划/经济学州卫生计划/统计学和数值数据美国老年人女(雌)性人类男(雄)性

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Prospects for national health care in the united states

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Journal of Health and Social Policy 1992年第3期3卷 1-17页

作者： Soifer, Steven Lou Balassone, Mary Johnstone, Jaime University of Washington School of Social Work Seattle WA 98195 4101 15th Avenue NE JH-30 United States

This paper provides an overview of both the current health care crisis in the United States and various reform proposals (some based on Canadian and British models) being considered at the federal and state levels. The proposals discussed fall into three categories—multiple payer national health insurance programs, one payer national health insurance programs, and a national health service program. The authors review four important criteria (cost, quality, access, and equity) that must be considered in evaluating the proposals for reform. Information is provided to assist health care professionals in understanding the various national health care proposals, applying evaluative criteria to these proposals, and advocating for needed changes. © 1992 Taylor and Francis Group, LLC.

关键词：加拿大费用效益分析大不列颠卫生经费支出/统计学和数值数据卫生经费支出/发展趋势卫生政策/经济学卫生政策/发展趋势卫生服务易得程度/组织和管理国家健康保险美国/经济学规划技术卫生保健质量州卫生计划/经济学州卫生计划/组织和管理州卫生计划/发展趋势美国

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PERSISTENCE IN THE USE OF PHARMACEUTICALS BY THE ELDERLY - EVIDENCE FROM ANNUAL CLAIMS

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JOURNAL OF HEALTH ECONOMICS 1992年第3期11卷 315-328页

作者： COULSON, NE STUART, B PENN STATE UNIV DEPT ECON608 KERN GRAD BLDGUNIV PKPA 16802 USA

An analysis of four-and-a-half years of claims data from the Pennsylvania Pharmaceutical Assistance Contract for the Elderly (PACE) program shows a pronounced degree of persistence in annual prescription drug expense by individual enrollees from year to year, particularly among the heaviest users. There is evidence of eventual regression to the mean, but it takes a substantial length of time - far longer than observed for other types of health care used by the elderly. The study findings raise questions about the insurability of drug expenses in non-group Medigap policies.

关键词：药物处方/统计学和数值数据卫生经费支出/统计学和数值数据卫生服务研究保险药剂师工作/统计学和数值数据保险药剂师工作/利用模型统计学宾夕法尼亚方案评价回归分析州卫生计划/经济学州卫生计划/统计学和数值数据美国老年人人类

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