Abstract:
BACKGROUND:Once just a small part of the Medicare program, private managed care plans now cover over one-third of all Medicare beneficiaries and cost the Federal government ~$210 billion each year. Importantly, the evolution of Medicare managed care policy has been far from linear; for several decades there have been dramatic shifts in the payment and regulatory policies facing private Medicare managed care plans. OBJECTIVES:This article presents a critical review of the history of Medicare managed care payment and regulatory policies and discusses the role of political ideology and stakeholder influence in shaping the direction of policy over time. CONCLUSIONS:As Medicare Advantage becomes an increasingly prominent area of focus for the health services, health policy, and medical research communities, it is important to bear in mind the highly political history of the program, the role of stakeholder influence in shaping the direction of policy, and to understand the historic barriers to evidence-based policymaking.
journal_name
Med Carejournal_title
Medical careauthors
Adrion ERdoi
10.1097/MLR.0000000000001256subject
Has Abstractpub_date
2020-03-01 00:00:00pages
285-292issue
3eissn
0025-7079issn
1537-1948journal_volume
58pub_type
杂志文章相关文献
MEDICAL CARE文献大全abstract:BACKGROUND:Efforts to identify hospital-acquired complications from claims data by applying exclusion rules to discharge diagnosis codes exhibit low positive predictive value (PPV). The PPV improves when a variable is added to each secondary diagnosis to indicate whether the condition was "present-on-admission" (POA) o...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0b013e3181589b92
更新日期:2008-02-01 00:00:00
abstract::In response to health care reform, health care providers have begun to develop interorganizational networks. At present, however, relatively little is known about factors facilitating participation in networks. To this end, organizational characteristics and views were obtained from key informants from both "Lead" and...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-199505000-00001
更新日期:1995-05-01 00:00:00
abstract:BACKGROUND:Medication adherence may be a proxy for healthy behaviors and other factors that affect outcomes. Prior studies of the association between placebo adherence and health outcomes have been limited primarily to men enrolled in clinical trials and cardiovascular disease outcomes. We examined associations between...
journal_title:Medical care
pub_type: 杂志文章,随机对照试验
doi:10.1097/MLR.0b013e318207ed9e
更新日期:2011-05-01 00:00:00
abstract:BACKGROUND:Though demand for mental health services (MHS) among US veterans is increasing, MHS utilization per veteran is decreasing. With health and social service needs competing for limited resources, it is important to understand the association between patient factors, MHS utilization, and clinical outcomes. OBJE...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/mlr.0b013e3181cafbe3
更新日期:2010-04-01 00:00:00
abstract:BACKGROUND:Hospital administrative health data create separate records for each hospital stay of patients. Treating a hospital transfer as a readmission could lead to biased results in health service research. METHODS:This is a cross-sectional study. We used the hospital discharge abstract database in 2013 from Albert...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0000000000000624
更新日期:2017-01-01 00:00:00
abstract::This study compares the characteristics of the practices and patients of recent graduates of family practice and general internal medicine residency programs. National samples of 104 family physicians and 134 general internists completed questionnaires and provided log-diary data for more than 7,500 office visits and ...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-198612000-00006
更新日期:1986-12-01 00:00:00
abstract:BACKGROUND:Latinos make up the largest group of minority children in the United States. Despite great diversity among Latino children, studies have traditionally treated them as a monolithic group. Few studies have examined patterns and determinants of access to and use of health care for different subgroups of Latino ...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0b013e318190d9e4
更新日期:2009-06-01 00:00:00
abstract:BACKGROUND:Social determinants of health (SDH) data collected in health care settings could have important applications for clinical decision-making, population health strategies, and the design of performance-based incentives and penalties. One source for cataloging SDH data is the International Statistical Classifica...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0000000000000764
更新日期:2017-09-01 00:00:00
abstract:BACKGROUND:Methods to select physicians most likely to benefit from educational interventions to improve the outcome of depression have not been adequately developed. OBJECTIVE:The purpose of this study was to identify a combination of primary care provider (PCP) self-report questions to improve the precision of PCP e...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-200007000-00009
更新日期:2000-07-01 00:00:00
abstract::In the 2 months immediately after a premium rate increase, the Genesee Valley Group Health Association (Group Health) lost over 600 subscriber contracts. A survey was conducted to determine the reasons for disenrollment and compare the demographic and utilization characteristics of disenrollees with those of all membe...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-198212000-00005
更新日期:1982-12-01 00:00:00
abstract::This study was initiated to determine the extent of hospital capacity reduction in large U.S. cities. In addition, hospital bed and service additions were analyzed. Study data indicate that between 1976 and 1978 more than 5,000 beds were closed in the 36 cities surveyed. This constitutes 2.7% of total hospital beds in...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-198007000-00004
更新日期:1980-07-01 00:00:00
abstract::The desired form and style of written drug information for patients were assessed in a national survey of oral contraceptive (OC) users. These women were queried about two forms of OC information: a short insert included with dispensed drugs and a longer brochure delivered by the physician upon patient request. Longer...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-197812000-00008
更新日期:1978-12-01 00:00:00
abstract:INTRODUCTION:Screening hospital patients for falls risk is now a contentious component of geriatric care despite its widespread clinical use. The economic implications of using a falls risk screening approach to deliver an effective falls prevention intervention have not previously been examined. METHODS:This was a mu...
journal_title:Medical care
pub_type: 杂志文章,多中心研究
doi:10.1097/MLR.0b013e318190ccc0
更新日期:2009-04-01 00:00:00
abstract:BACKGROUND:Applying disease-specific guidelines to people with multimorbidity may result in complex regimens that impose treatment burden. OBJECTIVES:To describe and validate a measure of healthcare task difficulty (HCTD) in a sample of older adults with multimorbidity. RESEARCH DESIGN:Cross-sectional and longitudina...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0b013e3182a977da
更新日期:2014-03-01 00:00:00
abstract::This article examines the quality of acute episodic care for five diagnostic categories amenable to one-visit diagnosis and treatment at the nation's largest chain of investor-owned ambulatory care centers. A total of 803 medical records were audited for five common conditions and measured against specific protocols. ...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-199101000-00007
更新日期:1991-01-01 00:00:00
abstract::Although self-care is emerging as a growing movement wherein lay persons are assuming more responsibility for prvention, detection and treatment of health problems, we have almost no basic descriptive studies of attitudes toward self-care of professionals and consumers. The present study explored the reliability and v...
journal_title:Medical care
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00005650-198008000-00009
更新日期:1980-08-01 00:00:00
abstract::Dummy variables frequently are used in regression analysis but often in an incorrect fashion. A brief review of examples in the medical care literature showed that the interpretation of dummy variable regression coefficients and their significance was often incorrect or unclear. This article shows how dummy variables ...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-198209000-00008
更新日期:1982-09-01 00:00:00
abstract:OBJECTIVE:Compare healthcare utilization and total payments for community-acquired pneumonia (CAP) episodes-of-care among 5 health plan designs spanning the continuum of managed care. RESEARCH DESIGN:Medical and prescription claims analysis of CAP episodes among enrollees of employer-sponsored health plans. Episode ch...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0b013e3181a8116d
更新日期:2009-10-01 00:00:00
abstract:BACKGROUND:Approximately 2.5 million Americans are admitted to the hospital after traumatic physical injury each year. Few investigations have elicited patients' perspectives regarding posttraumatic outcomes. OBJECTIVE:To identify and categorize physically injured trauma survivors' posttraumatic concerns. RESEARCH DE...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-200104000-00004
更新日期:2001-04-01 00:00:00
abstract::The acceptability of satisfaction as a quality indicator is qualified by several well known measurement problems. This study examines the variability in satisfaction evaluations related to different measurement methods and the effect of response biases on reported satisfaction. Satisfaction evaluations using seven dif...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-199504000-00006
更新日期:1995-04-01 00:00:00
abstract::Adherence to the medical regimen continues to rank as a major clinical problem in the management of patients with essential hypertension, as in other conditions treated with drugs and life-style modification. This article reviews the psychometric properties and tests the concurrent and predictive validity of a structu...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-198601000-00007
更新日期:1986-01-01 00:00:00
abstract:OBJECTIVES:To examine the association between on-site gynecology and availability of sex-specific services and policies in Department of Veterans Affairs (VA) emergency departments (EDs). RESEARCH DESIGN:Cross-sectional analysis using data from a VA national inventory of emergency services for women and gynecologist s...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0000000000000311
更新日期:2015-04-01 00:00:00
abstract:OBJECTIVE:To evaluate the effectiveness of standardized, patient-centered label (PCL) instructions to improve comprehension of prescription drug use compared with typical instructions. METHODS:A total of 500 adult patients recruited from 2 academic and 2 community primary care clinics in Chicago, IL and Shreveport, LA...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0b013e3181f38174
更新日期:2011-01-01 00:00:00
abstract::The ability of a medical self-care program to have an impact on the utilization and cost of in-clinic and referral visits in a prepaid group practice was studied by following the medical encounter records of 900 HMO members in 217 families during a 12-month period. A control group selected by randomization after accep...
journal_title:Medical care
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00005650-198207000-00006
更新日期:1982-07-01 00:00:00
abstract:OBJECTIVES:We conducted a theoretically guided study of access to inpatient or residential treatment among a probability sample of homeless adults with alcohol or drug use disorders in Houston, Texas. METHODS:This study used a cross-sectional, retrospective design with data collected from a multistage random sample of...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-200111000-00003
更新日期:2001-11-01 00:00:00
abstract::When studying variation in medicine, traditional hypothesis-testing procedures are too limited to obtain useful inferences except in special situations. More generally, full probability modelling is necessary. Even a relatively simple example can illustrate this point rather dramatically. The development and applicati...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-199305001-00017
更新日期:1993-05-01 00:00:00
abstract::Breast cancer is the most common neoplasm in North American women. The psychosocial impact of breast cancer has been extensively studied, and a number of investigators have attempted to characterize women who are at high risk for increased psychosocial morbidity. Although a detailed interview performed by a profession...
journal_title:Medical care
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00005650-199305000-00004
更新日期:1993-05-01 00:00:00
abstract:OBJECTIVES:Patient perceptions are increasingly used to measure quality of care in a diversity of health-care delivery settings. The goals of this article are to review the current use of patient perceptions and to review what is known about the sensitivity of patient perceptions for discerning variations in care acros...
journal_title:Medical care
pub_type: 杂志文章,评审
doi:10.1097/00005650-199711001-00007
更新日期:1997-11-01 00:00:00
abstract:BACKGROUND:Outcome measures, like hospital standardized mortality ratios (HSMRs), are increasingly used to assess quality of care. The validity of HSMRs and their accuracy to reflect quality of care is heavily contested. OBJECTIVE:We explored apparent and potential shortcomings and adverse effects of the HSMR in the a...
journal_title:Medical care
pub_type: 杂志文章,评审
doi:10.1097/MLR.0b013e31824ebd9f
更新日期:2012-08-01 00:00:00
abstract::This paper examines relationships between true and treated prevalence of mental illness in a community by examining the use of mental health and other professional services for emotional problems and the relationship of this use to the individual's diagnostic status. The results are based upon a third round of 515 int...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-198001000-00009
更新日期:1980-01-01 00:00:00