Grantee Publication

Continuing Care Retirement Communities: Prospects for Reducing Institutional Long-Term Care

Journal of Health Politics, Policy, and Law
Vol. 20, No. 1
Spring 1995
Sloan, F.A., Shayne, M., and C.J. Conover
pp. 75-98

Continuing care retirement communities (CCRCs) combine housing and long-term care (LTC) services, including personal and nursing home care. The amount of LTC that is prepaid varies by type of CCRC, with one-third offering extensive (fully prepaid) contracts for LTC. CCRCs are a potentially promising model for LTC delivery because they offer a full continuum of services and can substitute less expensive supportive care for institutional care.

Beneficiary Price Sensitivity in the Medicare Prescription Drug Plan Market

Health Economics
Vol. 19, No. 1
February 3, 2009
Frakt, A.B., and S.D. Pizer
pp. 88-100

The Medicare stand-alone prescription drug plan (PDP) came into existence in 2006 as part of the Medicare prescription drug benefit. It is the most popular plan type among Medicare drug plans and large numbers of plans are available to all beneficiaries. In this article we present the first analysis of beneficiary price sensitivity in the PDP market. Our estimate of elasticity of enrollment with respect to premium, -1.45, is larger in magnitude than has been found in the Medicare HMO market.

The Adequacy of Household Survey Data for Evaluating the Nongroup Health Insurance Market

Health Services Research - November 2006 Early Online Publication
Vol. 42, No. 4
November 2006
Cantor, J.C., Monheit, A.C., Brownlee, S., and C. Schneider
pp. 1739-57

Objective:

To evaluate the accuracy of household survey estimates of the size and composition of the nonelderly population covered by nongroup health insurance. 

Do "Any Willing Provider" and "Freedom of Choice" Laws Affect HMO Market Share

Inquiry
Vol. 349, No. 3
Winter 2003/2004
Morrisey M.A. and R.L. Ohsfeldt
pp. 2224-32

This study examines the effects of “any willing provider” (AWP) and “freedom of choice” (FOC) laws on the market share of health maintenance organizations (HMOs) in metropolitan statistical areas over the period 1989–95. We use pooled cross-section time-series regression techniques with year and state fixed effects. HMO market share is hypothesized to be a function of state laws, market characteristics, and state preference for managed care regulation. AWP and FOC laws are characterized by three alternative measures of regulatory intensity.

The Impact of Medicaid Expansion on Early Prenatal Care and Health Outcomes

Health Care Financing Review--March 2003
Vol. 19, No. 4
March 2003
Epstein, A.M. and J.P. Newhouse
pp. 85-99

To assess the impact of Medicaid expansion for pregnant women in South Carolina and California, the authors compared change in rates of timely prenatal care, adverse infant and maternal health outcomes, and use of cesarean section for groups of pregnant women who were either uninsured or covered by Medicaid, versus women with private coverage. The results showed small and/or inconsistent changes.

What We Know and Do Not Know About Tiered Provider Networks

Journal of Health Care Finance
Vol. 33, No. 4
Summer 2007
Thomas, J.W., Nalli, G.A., and A.F. Coburn
pp. 53-67

In response to continuing concerns about escalating health care costs and poor quality care, many health plans have adopted a strategy called "tiered provider networks." With TPNs, plans provide financial incentives for members to utilize hospitals, primary care physicians, and/or specialist physicians identified as performing especially well in terms of cost-efficient and/or high-quality care.  The strategy is relatively new, and little is known about TPN structure, implementation, or operation.  In this article, we present findings about tiered provider networks develo

State Regulation of Medical Necessity: The Case of Weight-Reduction Surgery

Duke Law Journal--November 2003
Vol. 53, No. 2
November 2003
Hall, M.A.
pp. 653-72

This study explores how state managed care patient protection laws affect health insurers' criteria for medical necessity, using weight reduction surgery as a case in point. Six states and three national insurers were selected for in-depth case studies to represent a range of market, demographic, and legal conditions. In each state, 10-12 qualitative interviews were conducted with insurers, regulators, providers, and health care attorneys, for a total of 71 interview subjects.

A Tale of Two Bounties: The Impact of Competing Fees on Physician Behavior

Journal of Health Politics, Policy, and Law
Vol. 24, No. 6
December 1999
Rice, T., Stearns, S., Pathman, D.E., DesHarnais, S., Brasure, M., and M. Tai-Seale
pp. 1307-30

This study examines how the volume of privately insured services provided in hospital inpatient and outpatient departments changes in response to reductions in Medicare physician payments. We hypothesize that physicians consider relative payment rates when choosing which patients to treat in their practices. When Medicare reduces its payments for surgical procedures, as it did in the late 1980s, physicians are predicted to treat more privately insured patients because they become more lucrative.

Using Medicaid Claims Data to Evaluate a Large Physician Fee Increase

Health Services Research
August 1994
Fox, M.H. and K.L. Phua

OBJECTIVE. This study demonstrates the use of Medicaid claims data in order to evaluate a threefold fee increase in physician fees for deliveries ($265 to $795), which the Maryland Medicaid program implemented in 1986. DATA SOURCES AND STUDY SETTING. The study used Maryland Medicaid claims data for years of service 1985-1988, and was done at the Maryland Department of Health and Mental Hygiene with the help of a Robert Wood Johnson, Health Care Financing and Organization (HCFO) grant. STUDY DESIGN.

Private Health Purchasing Practices in the Public Sector: A Comparison of State Employers and the Fortune 500

Health Affairs--March/April 2004
Vol. 23, No. 2
March/April 2004
Maxwell, J., Temi,n P., and T. Petigara
pp. 182-90

State governments are influential purchasers of health benefits but have not been studied extensively. In a recent survey of senior benefit managers, we examine the extent to which states have followed the private-sector approach to purchasing health care. We found that states have adopted "industrial purchasing" practices similar to those of large private employers but offer greater choice of carriers and pay a higher percentage of premiums. Unions continue to influence health care purchasing in both the public and private sectors.

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