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Declining payments for emergency department care, 1996-1998

ANNALS OF EMERGENCY MEDICINE 2003年第3期41卷 299-308页

作者： Tsai, AC Tamayo-Sarver, JH Cydulka, RK Baker, DW Case Western Reserve Univ Dept Epidemiol & Biostat Sch Med Cleveland OH 44106 USA Metrohlth Med Ctr Dept Emergency Med Cleveland OH USA Northwestern Univ Feinberg Sch Med Div Gen Internal Med Dept Med Chicago IL 60611 USA

Study objective: We describe recent trends in payments from different payer classes and assess their relative importance to the financial solvency of emergency departments. Methods: We used Medical Expenditure Panel Survey data from 1996 and 1998. The unit of analysis was the ED visit. Primary outcome measures were ED charges and payments. The independent variable of interest was payer class, and therefore, we limited our analysis to those either uninsured or covered by Medicare, medicaid, or private insurance. Results: From 1996 to 1998, a declining percentage of total charges were paid, from 60.3% to 53.0% (difference -7.3%;95% confidence interval [Cl] -11.3% to -3.5%). Although the percentage of total charges paid by medicaid, Medicare, and the uninsured remained constant, the percentage of total charges paid by the privately insured declined from 75.1% to 63.4% (difference -11.7%;95% Cl -16.6% to -6.7%). Overall, adjusted mean ED charge increased from $695 to $798 (difference $103;95% Cl $61 to $146). Two payer classes experienced statistically significant increases in adjusted mean charge: the uninsured, from $544 to $740 (difference $196;95% Cl $62 to $330), and the privately insured, from $658 to $813 (difference $151;95% Cl $103 to $199). Although the adjusted mean payment rate for the uninsured remained stable, the adjusted mean payment rate for the privately insured declined from 77.7% to 65.7% (difference -12.0%;95% Cl -13.4% to -10.7%). Conclusion: The ability of EDs to provide emergency care to all regardless of ability to pay is increasingly threatened by declining overall payment rates. Cost shifting to fund care for the uninsured is an increasingly untenable financing strategy.

关键词：急诊室医院/经济学急诊室医院/发展趋势卫生经费支出/统计学和数值数据保险范围/经济学保险范围/统计学和数值数据 medicaid/经济学 medicaid/统计学和数值数据未参加医疗保险者/统计学和数值数据 Medicare/经济学 Medicare/统计学和数值数据美国/流行病学人类

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Adherence to antiretroviral therapy by pregnant women infected with human immunodeficiency virus: A pharmacy claims-based analysis

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OBSTETRICS AND GYNECOLOGY 2000年第2期95卷 167-173页

作者： Laine, C Newschaffer, CJ Zhang, DZ Cosler, L Hauck, WW Turner, BJ Thomas Jefferson Univ Jefferson Med Coll Div Gen Internal Med Ctr Res Med Educ & Hlth Care Philadelphia PA 19107 USA Thomas Jefferson Univ Jefferson Med Coll Biostat Sect Div Clin Pharmacol Philadelphia PA 19107 USA New York State Dept Hlth Albany NY USA

Objective: To assess adherence to antiretroviral therapy with the use of medicaid pharmacy claims data for human immunodeficiency virus (HIV)-infected pregnant women and to identify associated maternal and health care factors. Methods: We retrospectively studied a cohort of 2714 HIV-infected women in New York State who delivered live infants from 1993-96;Among 682 women prescribed antiretroviral therapy in the last two trimesters, we studied 549 who started therapy more than 2 months before delivery. Adherence was defined as adequate if the supplied drug covered at least 80% of the days from the first prescription in the last two trimesters until delivery. Multivariable analyses were used to examine associations between maternal and health care factors and adherence. Results: Only 34.2% of 549 subjects had at least 80% adherence based on pharmacy data, a rate that remained stable over time. The adjusted odds ratios (ORs) of adherence for black (OR 0.47, 95% confidence interval [CI] 0.30, 0.75) and Hispanic (OR 0.49, 95% CI 0.29, 0.82) women were nearly 50% lower than for white women. The OR of adherence was 0.32 (95% CI 0.12, 0.90) for teenagers compared with women aged 25-29 years and 0.56 (95% CI 0.34, 0.92) for women in New York City versus those residing elsewhere. Women on antiretroviral therapy before pregnancy were more likely to adhere (OR 1.55, 95% CI 1.02, 2.35). Conclusion: Teenagers, women of minority groups, and women living in New York City had greater risks of poor antiretroviral adherence, whereas women already prescribed antiretrovirals before pregnancy had better adherence. Our conservative pharmacy data-based measure showed that most HIV -infected women adhered poorly and adherence did not improve over the 4-year study. (C) 2000 by The American College of Obstetricians and Gynecologists.

关键词：非洲裔美国人年龄因素抗HIV药/治疗应用队列研究置信区间 HIV感染/药物疗法 HIV感染/人种学西班牙裔美国人保险索赔审核/统计学和数值数据 medicaid/统计学和数值数据少数民族多元分析纽约/流行病学比值比病人依从/人种学病人依从/统计学和数值数据药学服务/经济学药学服务/统计学和数值数据妊娠并发症感染性/药物疗法妊娠并发症感染性/人种学回顾性研究美国市区人口妇女卫生青少年成年人女(雌)性人类妊娠

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Reasons for lack of health insurance explored

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AMERICAN JOURNAL OF HEALTH-SYSTEM PHARMACY 2000年第17期57卷 1573-1573页

作者： [Anonymous]

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Prediction of hospital readmission for heart failure: Development of a simple risk score based on administrative data

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JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY 1999年第6期33卷 1560-1566页

作者： Philbin, EF DiSalvo, TG Henry Ford Hosp Sect Heart Failure & Cardiac Transplantat Div Cardiovasc Med Detroit MI 48202 USA Massachusetts Gen Hosp Cardiac Unit Heart Failure & Transplantat Boston MA 02114 USA Harvard Univ Sch Med Boston MA 02115 USA

OBJECTIVES The purpose of this study waste develop a convenient and inexpensive method for identifying an individual's risk for hospital readmission for congestive heart failure (CHF) using information derived exclusively from administrative data sources and available at the time of an index hospital discharge. BACKGROUND Rates of readmission are high after hospitalization for CHF. The significant determinants of rehospitalization are debated. METHODS Administrative information on all 1995 hospital discharges in New York State which were. assigned International Classification of Diseases-9-Clinical Modification codes indicative of CHF in the principal diagnosis position were obtained. The following were compared among hospital survivors who did and did not experience readmission: demographics, comorbid illness, hospital type and location, processes of care, length of stay and hospital charges. RESULTS A total of 42,731 black or white Patients were identified. The subgroup of 9,112 patients (21.3%) who were readmitted were distinguished by a greater proportion of blacks, a higher prevalence of Medicare and medicaid insurance, more comorbid illnesses and the use of telemetry monitoring during their index hospitalization. Patients treated at rural hospitals, those discharged to skilled nursing facilities and those having echocardiograms or cardiac catheterization were less likely to be readmitted. Using multiple regression methods, a simple methodology was devised that segregated patients into low, intermediate and high risk for readmission. CONCLUSION Patient characteristics, hospital features, processes of care and clinical outcomes may be used to estimate the risk of hospital readmission for CHF. However, some of the variation in rehospitalization risk remains unexplained and may be the result of discretionary behavior by physicians and patients. (C) 1999 by the American College of Cardiology.

关键词：非洲裔美国人/统计学和数值数据非洲大陆世系人群共病现象欧洲大陆世系人群/统计学和数值数据心力衰竭/流行病学心力衰竭/人种学心力衰竭/康复 medicaid/统计学和数值数据 Medicare/统计学和数值数据纽约/流行病学结果与过程评价(卫生保健) 病人再入院/统计学和数值数据危险疾病严重程度指数美国老年人老年人 80以上女(雌)性人类男(雄)性中年人

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Risk factors for patient hospitalization

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AMERICAN JOURNAL OF HEALTH-SYSTEM PHARMACY 1999年第5期56卷 450-453页

作者： Saltsman, CL Hamilton, RA Albany Coll Pharm Div Pharm Practice Albany NY 12208 USA

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Utilization of services for mentally ill chemically abusing patients discharged from residential treatment

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JOURNAL OF BEHAVIORAL HEALTH SERVICES & RESEARCH 1999年第2期26卷 219-228页

作者： Maynard, C Cox, GB Krupski, A Stark, K Univ Washington Dept Med Seattle WA 98105 USA Univ Washington Inst Alcohol & Drug Abuse Seattle WA 98105 USA Dept Social & Hlth Serv Div Alcohol & Substance Abuse Olympia WA USA

Little is known about outcomes of treatment for individuals with mental illness and chemical dependencies. This article compares services utilization preadmission and postdischarge in 534 patients discharged from a residential treatment program in Washington State. A number of services, including chemical dependency detoxification, mental health crisis, inpatient psychiatric, medical emergency, and general medical inpatient hospitalization, were used less frequently in the period after discharge. The total reimbursement for all medicaid services decreased by 44% from $5 million in the year prior to discharge to $2.8 million in the year after discharge. Also, individuals (32%) who completed the program were less likely to use costly acute care services. This study was limited by the absence of a control group and posttreatment alcohol and drug use data. In addition, other unmeasured factors could have explained the association between program completion and better outcomes.

关键词：出院后医疗/利用门诊医疗/利用卡方分布 medicaid/统计学和数值数据病案连锁回归分析寄托治疗回顾性研究物质相关性障碍/流行病学物质相关性障碍/治疗治疗结果美国华盛顿/流行病学成年人女(雌)性人类男(雄)性

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Medicare spending by beneficiaries with various types of supplemental insurance

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MEDICAL CARE RESEARCH AND REVIEW 1999年第2期56卷 137-155页

作者： Khandker, RK McCormack, LA Res Triangle Inst Res Triangle Pk NC 27709 USA

The authors analyzed Medicare spending by elderly noninstitutionalized Medicare beneficiaries with and without supplemental insurance such as Medigap, employer-sponsored plans, and medicaid. Use of a detailed survey of Medicare beneficiaries and their Medicare health insurance claims enabled the authors to control for health status, chronic additions,functional limitations, and other factors that explain spending variations across supplemental insurance categories. The authors found that supplemental insurance was associated with a higher probability and level of Medicare spending, particularly for Part B services. Beneficiaries with both Medigap and employer plans had the highest levels of spending ceteris paribus, suggesting a possible moral hazard effect of insurance. Findings from this study are discussed in the context of the overall financing of health care for the elderly.

关键词：卫生经费支出/统计学和数值数据健康状况收入保险赔偿费保险 Medigap/经济学保险 Medigap/统计学和数值数据保险 Medigap/利用似然函数 Logistic模型 medicaid/经济学 medicaid/统计学和数值数据 medicaid/利用 Medicare/经济学 Medicare/统计学和数值数据 Medicare/利用统计学非参数美国人类男(雄)性

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Covering uninsured children and their parents: Estimated costs and number of newly insured

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MEDICAL CARE RESEARCH AND REVIEW 1999年第2期56卷 197-214页

作者： Thorpe, KE Florence, CS Tulane Univ Sch Publ Hlth & Trop Med New Orleans LA 70118 USA

The Child Health Insurance Program (CHIP) supplies $20.4 billion over 5 years and nearly $50 billion over 10 years to extend health insurance to uninsured children with family incomes up to 200 percent of poverty. This article analyzes the March 1997 Current Population Survey estimating the number of children likely to be eligible for CHIP or currently eligible for medicaid. Of the 8.6 million parents of uninsured children,four out of five were uninsured at the time of the survey. Expanding coverage to parents as well as children could make program participation more attractive and simplify the enrollment process. If 75 percent of uninsured parents of CHIP eligible children participated, 1.7 million parents could be insured, costing federal and state governments 3.4 billion. Another 3.4 million parents would be insured by expanding medicaid to cover uninsured parents of Medical-eligible children.

关键词： medicaid/立法和法学 medicaid/统计学和数值数据未参加医疗保险者/统计学和数值数据美国

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Psychiatric hospitalization characteristics associated with insurance type

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ADMINISTRATION AND POLICY IN MENTAL HEALTH 1998年第4期25卷 437-448页

作者： Hendryx, MS DeRyan, J Washington State Univ Washington Inst Mental Illness Res & Training Spokane WA USA Washington State Univ Dept Psychol Spokane WA USA Washington State Univ Program Hlth Policy & Adm Spokane WA USA

This study examines the relationship among types of insurance and characteristics of inpatient psychiatric treatment. Data include 46,998 adult psychiatric or substance abuse cases from all 1991-1992 Washington State discharges from short-stay general hospitals. Large and significant differences among payers exist in treatment characteristics, controlling for diagnosis and patient age. For example, length of stay is longest among commercial and Medicare payers. Emergency admissions are more common among public payers, and elective admissions are more common among private payers, including HMOs, Results are discussed in light of policy and administration issues that will arise as financing for mental health services comes under greater capitation.

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DO ELDERLY medicaid PATIENTS EXPERIENCE REDUCED ACCESS TO NURSING-HOME CARE

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JOURNAL OF HEALTH ECONOMICS 1993年第3期12卷 259-280页

作者： ETTNER, SL HARVARD UNIV SCH MEDDEPT HLTH CARE POLICY25 SHATTUCK STPARCEL B1ST FLOORBOSTONMA 02115 USA

This paper uses data from the National Long-Term Care Survey and the Area Resources File to analyze the problem of diminished access to nursing home care for elderly medicaid patients. Using a proxy for the length of time on a waiting list before nursing home entry as my measure of access, I find evidence suggesting that nursing home operators in some areas preferentially admit private patients. Waitlisting of medicaid patients appears to be a problem mainly in counties in which a high proportion of potential nursing home patients are private and counties in which bed supply is low.

关键词：卡方分布数据收集残疾人/统计学和数值数据卫生服务易得程度/统计学和数值数据老人疗养院/经济学 medicaid/统计学和数值数据医护疗养所/经济学病人入院/经济学回归分析美国预约名单老年人人类

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