Abstract:
OBJECTIVES:To examine variation in risk-adjusted reinsurance payments across Part D plans, analyze its implications for the program, and explore options to reduce reinsurance payments. DATA/STUDY DESIGN:2007-2015 Part D Plan Payment and Premium data; 2010-2013 Part D Prescription Drug Event data; and 2013 Part D Plan Formulary Files. PRINCIPAL FINDINGS:Risk-adjusted reinsurance payments varied widely across plans at a given out-of-pocket (OOP) premium. The variance in risk-adjusted reinsurance in common OOP premium ranges increased between 2010 and 2015. High risk-adjusted reinsurance payments were negatively correlated with use of utilization management tools for high-cost drugs. CONCLUSIONS:Growing reinsurance payments shrink plans' liability for managing drug spending for high-cost enrollees, creating plan moral hazard, and making OOP premiums a noisy signal of plans' total costs.
journal_name
Health Serv Resjournal_title
Health services researchauthors
Jung J,Feldman Rdoi
10.1111/1475-6773.12866subject
Has Abstractpub_date
2018-12-01 00:00:00pages
4371-4380issue
6eissn
0017-9124issn
1475-6773journal_volume
53pub_type
杂志文章abstract:OBJECTIVE:To identify patient characteristics and health care experiences associated with primary care linkage after alcohol or drug detoxification. DATA SOURCES/STUDY SETTING:Primary data collected over two years. Subjects were adults without primary medical care, in an urban residential detoxification program. STUD...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/j.1475-6773.2004.00246.x
更新日期:2004-06-01 00:00:00
abstract:OBJECTIVE:To examine measures of need for health care and their relationship to utilization of health services in different racial and ethnic groups in California. DATA SOURCE:Telephone interviews obtained by random-digit dialing and conducted between April 1993 and July 1993 in California, with 7,264 adults (ages 18-...
journal_title:Health services research
pub_type: 杂志文章
doi:
更新日期:1996-12-01 00:00:00
abstract:OBJECTIVE:We evaluate the effects of the Nursing Home Quality Initiative (NHQI), which introduced quality measures to the Centers for Medicare and Medicaid Services' Nursing Home Compare website, on facility performance and consumer demand for services. DATA SOURCES:The nursing home Minimum Data Set facility reports f...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/j.1475-6773.2011.01298.x
更新日期:2011-12-01 00:00:00
abstract:OBJECTIVE:To test the hypothesis that health systems provide better care to patients with high needs by comparing differences in quality between system-affiliated and nonaffiliated physician organizations (POs) and to examine variability in quality across health systems. DATA SOURCES:2015 Medicare Data on Provider Pra...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/1475-6773.13570
更新日期:2020-12-01 00:00:00
abstract:OBJECTIVE:We evaluate the impact of membership in a staff-model health maintenance organization (HMO) on hospital admission rates for patients presenting to an emergency department with acute chest pain. DATA SOURCES AND STUDY SETTING:Primary prospective data were gathered from all 3,006 patients presenting with a chi...
journal_title:Health services research
pub_type: 杂志文章
doi:
更新日期:1994-04-01 00:00:00
abstract:OBJECTIVES:To compare different methods for defining screening mammograms with Medicare claims and their impact on estimates of breast cancer screening rates. METHODS:Medicare outpatient facility and physician claims for 61,962 women in 1993 and 59,652 women in 1998 were reviewed for evidence of receipt of screening m...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/1475-6773.10912
更新日期:2002-12-01 00:00:00
abstract:OBJECTIVE:The Standard Gamble (SG) technique is recommended for measurement of individuals' preferences under uncertainty and to express the outcome of different therapeutic choices in utility values to be used in clinical decision analysis and health program evaluation. The article alerts users of this technique to pr...
journal_title:Health services research
pub_type: 杂志文章
doi:
更新日期:1994-06-01 00:00:00
abstract:OBJECTIVE:The objective of this study was to assess nonresponse error in telephone health survey data based on an address-based sample. DATA SOURCES:Telephone and in-person interviews in Greater Boston. STUDY DESIGN/DATA COLLECTION:Interviewers attempted telephone interviews at addresses that were matched to telephon...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/1475-6773.13110
更新日期:2019-06-01 00:00:00
abstract:OBJECTIVE:To quantify between-unit variability in mean length of stay (LoS) between intensive care units (ICUs) after adjusting for differences in case mix using a method that does not require arbitrary trimming of data. SETTING:An analysis of registry data from pediatric ICUs (PICUs) in Australia and New Zealand. ST...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/j.1475-6773.2012.01421.x
更新日期:2012-12-01 00:00:00
abstract:OBJECTIVE:To compare utilization and preventive care receipt among patients of federal Section 330 health centers (HCs) versus patients of other settings. DATA SOURCES:A nationally representative sample of adults from the Medical Expenditure Panel Survey (2004-2008). STUDY DESIGN:HC patients were defined as those wit...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/1475-6773.12178
更新日期:2014-10-01 00:00:00
abstract:OBJECTIVE:To determine how the inclusion of post-acute evaluation and management (E&M) services as primary care affects assignment of Medicare beneficiaries to accountable care organizations (ACOs). DATA SOURCES:Medicare claims for a random 5 percent sample of 2009 Medicare beneficiaries linked to American Medical Ass...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/1475-6773.12032
更新日期:2013-08-01 00:00:00
abstract:OBJECTIVE:To estimate the effect of a nursing home's share of residents with a serious mental illness (SMI) on the quality of care. DATA SOURCES:Secondary nursing home level data over the period 2000 through 2008 obtained from the Minimum Data Set, OSCAR, and Medicare claims. STUDY DESIGN:We employ an instrumental va...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/1475-6773.12023
更新日期:2013-08-01 00:00:00
abstract::The relationship between income and health is well established: the higher an individual's income, the better his or her health. However, recent research suggests that health may also be affected by the distribution of income within society. We outline the potential mechanisms underlying the so-called relative income ...
journal_title:Health services research
pub_type: 杂志文章,评审
doi:
更新日期:1999-04-01 00:00:00
abstract::One method used to determine utilization rates of cervical screening is women's self-report. Few studies have assessed the accuracy of this measure--none has been conducted in Australia--although there are a number of reasons for suspecting its validity. This study examined and quantified the accuracy of self-report o...
journal_title:Health services research
pub_type: 杂志文章
doi:
更新日期:1991-04-01 00:00:00
abstract:OBJECTIVE:To determine whether (a) quality in schizophrenia care varies by race/ethnicity and over time and (b) these patterns differ across counties within states. DATA SOURCES:Medicaid claims data from California, Florida, New York, and North Carolina during 2002-2008. STUDY DESIGN:We studied black, Latino, and whi...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/1475-6773.12296
更新日期:2015-10-01 00:00:00
abstract::Previous research has confirmed that desirable hospital attributes as well as increased distance, or travel time, have an impact on hospital choice. These studies have become increasingly sophisticated in modeling choice. This study adds to the existing literature by estimating the effect of both hospital and individu...
journal_title:Health services research
pub_type: 杂志文章
doi:
更新日期:1991-12-01 00:00:00
abstract:OBJECTIVE:This study examines the degree to which a married individual's health habits and use of preventive medical care are influenced by his or her spouse's behaviors. STUDY DESIGN:Using longitudinal data on individuals and their spouses, we examine changes over time in the health habits of each person as a functio...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/j.1475-6773.2007.00754.x
更新日期:2008-02-01 00:00:00
abstract:OBJECTIVE:To examine the implications of serious and chronic health problems on the willingness of enrollees to switch health plans if they are dissatisfied with their current arrangements. DATA SOURCE:A large (20,283 respondents) survey of employees of three national corporations committed to the model of managed com...
journal_title:Health services research
pub_type: 杂志文章
doi:
更新日期:1999-06-01 00:00:00
abstract:OBJECTIVE:To test whether nonprofit, for-profit, or government hospital ownership affects medical service provision in rural hospital markets, either directly or through the spillover effects of ownership mix. DATA SOURCES/STUDY SETTING:Data are from the American Hospital Association, U.S. Census, CMS Healthcare Cost ...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/j.1475-6773.2011.01280.x
更新日期:2011-10-01 00:00:00
abstract::We examined the effect of the Delphi iteration procedure in developing explicit criteria for ambulatory care assessment. Practicing internists chose items they believed to be essential with regard to the care of certain specified conditions. The initial responses were tabulated and "fed-back" to the participants. The ...
journal_title:Health services research
pub_type: 杂志文章
doi:
更新日期:1979-01-01 00:00:00
abstract:BACKGROUND:The Resource-Based Relative Value Scale Update Committee (RUC) submits recommended reimbursement values for physician work (wRVUs) under Medicare Part B. The RUC includes rotating representatives from medical specialties. OBJECTIVE:To identify changes in physician reimbursements associated with RUC rotating...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/1475-6773.12857
更新日期:2018-12-01 00:00:00
abstract:OBJECTIVE:To understand public attitudes about and recommendations to address antibiotic overuse by employing public deliberation (a method for eliciting informed input on value-laden issues). DATA SOURCES/STUDY SETTING:Participants in 24 Community Deliberation groups (CD; n = 263), four Citizens' Panel groups (CP; n ...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/1475-6773.13175
更新日期:2019-12-01 00:00:00
abstract:OBJECTIVES:To compare the ability of two diagnosis-based risk adjustment systems and health self-report to predict short- and long-term mortality. DATA SOURCES/STUDY SETTING:Data were obtained from the Department of Veterans Affairs (VA) administrative databases. The study population was 78,164 VA beneficiaries at eig...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/j.1475-6773.2006.00622.x
更新日期:2007-04-01 00:00:00
abstract:OBJECTIVE:To compare health care utilization between Canadian and U.S. residents. DATA SOURCES:Nationally representative 2007 surveys from the Medical Expenditure Panel Survey for the United States and the Canadian Community Health Survey for Canada. STUDY DESIGN:We use descriptive and multivariate methods to examine...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/j.1475-6773.2012.01466.x
更新日期:2013-04-01 00:00:00
abstract:OBJECTIVES:To provide updated estimates of narrow- and broad-spectrum antibiotic use among U.S. children. DATA SOURCES:Linked nationally representative data from the 2004-2010 Medical Expenditure Panel Survey Household Component and the 2000 Decennial Census. STUDY DESIGN:Relationships between individual-, family-, a...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/1475-6773.12260
更新日期:2015-06-01 00:00:00
abstract:OBJECTIVE:To discuss and quantify the incentives that Medicare managed care plans have to avoid (through selective enrollment or disenrollment) people who are at risk for very high costs, focusing on Medicare beneficiaries in the last year of life-a group that accounts for more than one-quarter of Medicare's annual exp...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/j.1475-6773.2004.00218.x
更新日期:2004-02-01 00:00:00
abstract:OBJECTIVE:To evaluate the effects of depression treatment in primary care on patients' clinical status and employment, over six months. DATA SOURCES/STUDY SETTING:Data are from a randomized controlled trial of quality improvement for depression that included 938 adults with depressive disorder in 46 managed primary ca...
journal_title:Health services research
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.1111/1475-6773.01086
更新日期:2002-10-01 00:00:00
abstract::All admissions to a 1,100-bed Department of Veterans Affairs (VA) hospital were screened to identify 171 terminally ill patients with informal caregivers who were then randomly assigned to VA hospital-based team home care (HBHC, N = 85) or customary care (N = 86). Patient functioning, and patient and caregiver morale ...
journal_title:Health services research
pub_type: 临床试验,杂志文章,随机对照试验
doi:
更新日期:1992-02-01 00:00:00
abstract:OBJECTIVE:To examine whether nurse practitioner (NP)-assigned patients exhibited differences in utilization, costs, and clinical outcomes compared to medical doctor (MD)-assigned patients. DATA SOURCES:Veterans Affairs (VA) administrative data capturing characteristics, outcomes, and provider assignments of 806 434 VA...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/1475-6773.13246
更新日期:2020-04-01 00:00:00
abstract::Limited information exists concerning lifetime use of nursing home services by the aged. This article examines the longitudinal experience, over four years, of elderly individuals at high risk of institutionalization, and develops a simple model of nursing home use based on these observations. This model allows us to ...
journal_title:Health services research
pub_type: 杂志文章
doi:
更新日期:1986-06-01 00:00:00