Browsing by Subject "Medicare"
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Item A study of the impact of medicare prospective payment system on hospital cost containment activities(Texas Tech University, 1986-12) Cassidy, Judith HelenThe purpose of this study was to assess the impact of the change in Medicare payment method, from cost-based to fixed-price prospective payment, on cost containment and revenue enhancing activities in hospitals. The study had two primary objectives: (1) to identify changes in the use of "good" management techniques which may be the result of changes in Medicare payment method, and (2) to determine the influence of Medicare and other hospital characteristics (size, ownership, affiliation with other hospitals, management, occupancy rate, nonpayment rate, and competition) on the use of "good" management techniques before and after Medicare Prospective Payment System (PPS) was enacted. A set of management techniques was identified by the General Accounting Office (GAO) in 1980 as effective in controlling costs. The set of "good" management techniques in this study combines techniques identified by the GAO with others from the hospital literature that are effective in reducing costs and enhancing revenues. Techniques were grouped into those related to: (1) purchasing, (2) energy conservation, (3) general management, and (4) revenue enhancement. The study hypothesized a model of cost containment in which Medicare, moderated by payment method, and other hospital characteristics determine whether a hospital uses few or many of the techniques within each category. The group of hospitals used in the study was community hospitals in Texas. The administrators of these hospitals were asked to complete a questionnaire on which techniques are used in their hospital and when the techniques were implemented. Demographic data were obtained from the questionnaire and listings with Texas Hospital Association. Changes in the use of "good" management techniques subsequent to PPS were identified using tests of means and proportions. The influence of Medicare and other hospital characteristics on the use of "good" management techniques before enactment of PPS was determined using discriminant analysis. The influence subsequent to PPS was determined using regression analysis. The results indicated that there have been significant increases in the use of "good" management techniques subsequent to enactment of PPS. Hospitals of greater size and affiliated with other hospitals used more of the techniques prior to enactment of PPS. Greater Medicare dependency characterized those hospitals using fewer of the techniques. This is support for the theory that cost-based Medicare payments provided a disincentive for cost containment. Subsequent to enactment of PPS, those hospitals with greater proportions of their revenues derived from fixed-price Medicare payments have added more than the average number of good management techniques for all hospitals. This supports the theory that fixed-price prospective rate setting provides incentives for cost containment.Item Impact of Medicare Part D on prescription use, health care expenditures, and health services utilization : national estimates for Medicare beneficiaries and vulnerable populations, 2002 to 2009(2012-08) Cheng, Lung-I; Rascati, Karen L.; Barner, Jamie C.; Lawson, Kenneth A.; Strassels, Scott A.; Warner, David C.The purpose of this study was to investigate the impact of Medicare Part D on prescription utilization, health services utilization, and health care expenditures in the general Medicare population – as well as Medicare sub-populations, including non-Hispanic blacks (NHBs), Hispanics, near poor individuals, and persons with higher disease burden. A retrospective analysis of Medicare beneficiaries (N=32,228) was conducted using the Medical Expenditure Panel Survey 2002 to 2009 data. Multivariable quantile regression was used to estimate the following outcomes, adjusting for socio-demographic characteristics: 1) number of prescription fills; 2) out-of-pocket (OOP) drug expenditures; 3) total drug expenditures; 4) OOP health care expenditures; 5) total health care expenditures; 6) number of hospitalizations; and 7) number of emergency department (ED) visits between the pre-Part D (2002-2005) and post-Part D (2006-2009) periods. All expenditures were inflation-adjusted to 2009 dollars. The average age of the study sample was 71.0 (SD=14.5). In the general Medicare population, Part D was associated with decreases in OOP drug expenditures (-25.7% to -33.6%; p<0.0001) and OOP health care expenditures (-22.1% to -24.3%; p<0.0001) as well as increases in the number of prescription fills (5.8% to 8.4%; p<0.0001) and total drug expenditures (75th percentile: 5.5%; 90th percentile: 10.2%; p<0.0001). Part D was not associated with changes in total health care expenditures in the general Medicare population. Changes in hospitalizations and ED visits were tested at the 90th percentile, and the results were not statistically significant. In sub-group analyses based on race/ethnicity, non-Hispanic whites (NHWs) experienced more significant reductions in OOP drug and/or health care expenditures when compared with NHBs and Hispanics. Near poor beneficiaries experienced larger reductions in OOP drug expenditures than beneficiaries with middle- to high-income, while Medicare beneficiaries with three or more conditions experienced more substantial reductions in OOP drug and OOP health expenditures after Part D was introduced, compared with those with fewer than three conditions. Part D resulted in increases in medication utilization and reductions in OOP drug and OOP health care expenditures among Medicare beneficiaries. Part D was not associated with differences in total health care spending. The effects of Part D were more pronounced in Medicare subgroups, including NHWs, near poor individuals, and patients with higher chronic disease burden.Item Older adults navigating health care: When benefits are denied(2012-05) Aranha, Karen M.; Bell, Nancy J.; Dunham, Charlotte C.; Mulsow, MiriamThe purpose of this study was to explore the experiences and perceptions of elderly beneficiaries who have been denied health services by Medicare. With the adoption of devolution and a consumer driven health care system following the Medicare Modernization Act of 2003, informed consumers are essential to ensure equitable access to health care. Examining Medicare consumers’ access to care and the challenges they face is important, not only for Medicare recipients but because Medicare’s rules and payment approaches for health services are often adopted by private insurers. Bourdieu’s theory of practice and symbolic violence provided the theoretical framework for conceptualizing the structure-agency dialectic of Medicare-beneficiary transactions. The method of this study, including sampling, interview, and analysis procedures, was guided by Interpretive Phenomenology. Semi-structured interviews were conducted with twelve individuals who had experienced denial of Medicare services (four beneficiaries, 65 years and older, and eight proxy navigators who had acted on behalf of elderly beneficiaries). Of the five main topics and associated themes identified in the analysis, there was strong consensus among respondents in four areas. These were the perception of Medicare at the time of enrollment, the use of Medicare resources, the consequences of denial of Medicare services, and participants’ perceptions of Medicare following denial of services. Denial of services was seen by the respondents as having a major physical, psychological, and financial impact. The resulting perception of Medicare was as a cumbersome, difficult to negotiate system where the beneficiary was often the ultimate loser. Variation among participants occurred in the fifth topic area—actions taken in response to denial of services. Seven respondents told an essentially passive narrative in response to this denial, but five others took a more active, agentic stance, engaging in various ways with the medical system in an attempt to have their needs met. Exploring lived experiences of beneficiaries and their families when beneficiaries face the challenge of not qualifying for needed medical coverage sheds light on the nature of interactions that take place between Medicare and the respective beneficiaries and their families, and the impact of such experiences. There is a need to expose pitfalls beneficiaries are likely to experience in this climate of cost containment and rationing of health care. Findings of this study and others like it can increase the awareness of beneficiaries and policy makers of the current state of equity of access to health care.Item A structure by no means complete : a comparison of the path and processes surrounding successful passage of Medicare and Medicaid under Lyndon Baines Johnson and the failure to pass national health care reform under William Jefferson Clinton(2009-08) Johnson, David Howard; DiNitto, Diana M.In this comparative policy development analysis, I utilize path-dependence theory and presidential records to analyze President Lyndon Johnson's success in passing Medicare and Medicaid and President Bill Clinton's failure to pass national health care reform. Findings support four major themes from the Johnson administration: 1) President Johnson had a keen understanding of the importance of language in framing debate; 2) He placed control of the legislative process in the hands of a small, select group of seasoned political operatives and career policymaking professionals; 3) He paid considerable attention to the details of negotiations and the policy consequences; and 4) He had a highly developed sense of the political and legislative processes involved in passing major legislation. The case study of the Clinton administration reveals five major themes: 1) There is a lack of evidence that President Clinton remained actively engaged throughout the policy development and legislative processes, instead choosing to delegate the process to the First Lady; 2) There was a naiveté on the part of the Clintons and many administration staff members with regard to the legal and political ramifications of their decisions; 3) The Clintons tried to make the plan fully their own, sharing little credit for its development with Congress; 4) Their attempts to incorporate existing corporate health care delivery structures with their vision for universal coverage proved unworkable; and 5) The extended time from task force launch to bill delivery gave opponents ample time to marshal their opposition forces. I conclude that in developing health care legislation, Johnson had the advantages of: 1) a small group of key policymakers; 2) multiple, simultaneous legislative initiatives which diffused the attention of a more limited media; and, 3) national crises which promoted an environment conducive to sweeping policy change. I suggest that major, national health care reform will not occur until: 1) an economic or geopolitical crisis sets the stage for change; 2) business interests and progressive interests find common ground; and, 3) Americans achieve a new cultural understanding of universal health care as both economically just and economically necessary.Item The cost of dying on Medicare: an analysis of expenditure data(Texas A&M University, 2005-11-01) House, Donald ReedRoughly one third of Medicare expenditures are made on behalf of beneficiaries in their terminal year, though only five percent of the Medicare-covered population dies annually. Per-capita spending on decedents is as much as six times the level of spending on survivors. The demographic, technological and political trends that will determine the future path of spending on terminal-year beneficiaries have important implications for the fiscal well-being of the Medicare program, and by extension, the American taxpayer. Coming to an understanding of the moving parts that will control the path of the cost of dying on Medicare is vital for careful consideration of Medicare??s future, and for any discussions about further reform of the program. Analysis of expenditures in the terminal year must be made while keeping in mind the fact that major expenditures are often made in surviving years. The spike in spending in the terminal period rightly focuses attention to expenditures near death, but also we should proceed in its analysis keeping in mind that it is not the only spell of elevated medical spending for a typical individual. Given those cautions, however, the cost of dying on Medicare stands as an important area of economic inquiry and policy consideration. As total Medicare expenditures top a quarter trillion dollars, the third of that spending which covers treatments in beneficiaries?? terminal years ought to be understood more fully than it is currently.