Home Health Use In Medicare Advantage Compared To Use In Traditional Medicare.

Medicare covers home health benefits for homebound beneficiaries who need intermittent skilled care. While home health care can help prevent costlier institutional care, some studies have suggested that traditional Medicare beneficiaries may overuse home health care. This study compared home health use in Medicare Advantage and traditional Medicare, as well as within Medicare Advantage by beneficiary cost sharing, prior authorization requirement, and plan type.

Can Insurance Market Competition Coexist With Provider Price Regulation? Evidence From Medicare Advantage.

Proposals to contain health care costs often draw from 1 of 2 primary policy approaches-price regulation or market competition. These approaches are often viewed as in conflict, even though some health economists have long argued that they may be compatible, and desirable, given the unique characteristics of health care markets. Medicare Advantage (MA) markets provide a real-world example supporting the view that provider price regulation and insurance market competition can be complementary.

Financing long-term services and supports: challenges, goals, and needed reforms.

The need for long-term services and supports (LTSS) presents a growing financial burden on disabled individuals, their families, and state Medicaid budgets. Strategies for addressing this problem pose both a policy design and a political challenge. This article begins by explaining the choices and trade-offs policy makers face in designing new policy and offers the outlines of a specific approach to navigating these.

"Mind the Gap": Researchers Ignore Politics at Their Own Risk.

No matter how distasteful researchers find policy politics, effective policy requires that they engage. Drawing on her career bridging the research/politics gap in health care policy, the author makes a case for why and how researchers can do just that.

A Matter of Choice: Opportunities and Obstacles Facing People with ESRD.

Kidney failure is an overwhelming, life-shattering event, but patients with ESRD do not see themselves as being at the end stage of their lives. On the contrary, patients opting for kidney dialysis are choosing to live. Ideally, then, public policy would support patients' choices about how to live-specifically, the choice to continue working.

Why employers will continue to provide health insurance: the impact of the Affordable Care Act.

The Congressional Budget Office, the Rand Corporation, and the Urban Institute have estimated that the Patient Protection and Affordable Care Act (ACA) will leave employer-sponsored coverage largely intact; in contrast, some economists and benefit consultants argue that the ACA encourages employers to drop coverage, thereby making both their workers and their firms better off (a "win-win" situation). This analysis shows that no such "win-win" situation exists and that employer-sponsored insurance will remain the primary source of coverage for most workers. Analysis of three issues-the terms of the ACA, worker characteristics, and the fundamental economics of competitive markets-supports this conclusion.

Unmet long-term care needs: an analysis of Medicare-Medicaid dual eligibles.

People who are dually eligible for Medicare and Medicaid are the focus of fiscal struggles between federal and state governments. Drawing on a survey of community-based elderly "dual eligibles," this paper examines how well their medical and long-term care needs are being met under the current combination of Medicare and Medicaid policies. While few people report difficulty getting medical care, 58% of people needing long-term care (help with activities of daily living) report unmet needs.

Health policy roundtable--policy by numbers: the role of budget estimates and scoring in health care reform.

The purpose of this roundtable is to explore the imperfect art of estimating the budget costs of health insurance proposals-called scoring when done by government agencies. The panel addresses the complexities involved in generating these estimates, which usually depend on many untested and untestable assumptions. For example, the Medicare prescription drug "donut hole" was invented so that policymakers could achieve budget targets.

How physicians will benefit under Clinton's plan.

President Clinton's healthcare reform plan will be good for primary care physicians, according to Judith Feder, one of the administration's top health policy advisers. During a 20-minute phone interview recently, she told postgraduate medicine that the goal is to reduce governmental and other kinds of hassles for practitioners while holding them accountable for results. Her responses to other concerns of physicians follow.