Unbiased Analysis of Today's Healthcare Issues
For the under-65 population insured by Blue Cross, total spending per-member-year in McAllen, Texas, was 7 percent lower than in El Paso, Texas. By contrast, Atul Gawande’s 2009 New Yorker article, which used data from theDartmouth Atlas of Health Care on variations in Medicare spending, showed that per capita spending in McAllen was 86 percent higher…
Do Medicare beneficiaries in fee-for-service plans access better physicians than those in Medicare Managed Care (MMC) plans? Huesch (2010) attempts to answer this question for beneficiary access to quality cardiologists. Using data on heart patients without AMI in Florida, the authors observes the following results: “No evidence was found that Medicare payor type significantly influenced…
From the Commonwealth Fund: “The analysis says people have many plans to choose from but that enrollment is concentrated in a handful. It notes, for example, that the average Medicare beneficiary in 2010 has 33 plans from which to choose. But in 14 states and the District of Columbia, a single company (not the same…
The increased use of long-term care (LTC) services has been one of the forces increasing health care cost and utilization. Currently, 10.3 million Americans use LTC services. The Kaiser Family Foundation provides a summary of LTC Services and Supports in the U.S. Who uses LTC? One can divide LTC services into those who receive care…
How well does Medicare measure quality? Not very well, especially across different treatment settings. According to a RAND report: “Only 10 clinical conditions are addressed by reporting programs for more than one setting. Three clinical conditions are included in programs for three settings: (1) acute myocardial infarction, (2) perioperative/surgical care, and (3) urinary incontinence. Seven…
Today, I will review an excellent piece of investigative journalism on Medicare’s end-stage renal disease (ESRD) program. The program provides free access to medical care for patients with kidney disease. Some highlights of these ProPublica report include the following: Program Inception “…the new program would help about 11,000 Americans, just for starters. For a modest…
Many states rely on managed care organizations (MCOs) to provide medical services for their Medicaid beneficiaries. Contracting out medical services to private providers relies on the government’s capacity to accurately predict expected cost of care for each beneficiary. This is typically done through risk-adjusted capitation rates. Which risk adjustment strategy works best? The answer of…
Most people know that in the U.S., all Americans (i.e., citizens or permanent residents) are eligible for Medicare once they turn 65. However, the benefits are not the same for all individuals. For instance, the following groups can receive Part A Medicare coverage without paying a premium: Individuals who already get retirement benefits from Social…
Why are hospitalization rates so high for Medicare beneficiaries living in long-term care facilities (i.e., skilled nursing facilities, nursing facilities, and assisted living facilities)? The first reason is obvious: they are sick. If they weren’t, they wouldn’t need to be living in these facilities in the first place. Hospitalizing sick patients is often necessary. Unnecessary…
Medicare spends a lot of money on beneficiaries living in nursing homes. How expensive are these beneficiaries: Six percent of Medicare beneficiaries spend some time in a long-term care facility, but these same beneficiaries make up 17% of total Medicare cost. Three percent of Medicare beneficiaries spent an entire year in a long-term care facilities.…