Insurance coverage of prescription drugs and the rural elderly.

Context: Rural impacts of a Medicare drug benefit will ultimately depend on the number of elderly who are currently without drug coverage, new demand by those currently without coverage, the nature of the new benefit relative to current benefits, and benefit design.

Purpose: To enhance understanding of drug coverage among rural elderly Medicare beneficiaries and their expenditures for pharmaceuticals.

Methods: Estimates of the extent of coverage, expenditures, and sources of drugs were obtained using data are from the 1997 Medicare Current Beneficiary Survey and the Pharmacy Verification and Household Components of the 1996 Medical Expenditure Panel Survey.

Medical resource use and costs among rheumatoid arthritis patients receiving disease-modifying antirheumatic drug therapy.

Objective: To identify costs among rheumatoid arthritis (RA) patients receiving alternative disease-modifying antirheumatic drug (DMARD) therapies.

Methods: Using managed care organization data, we identified members who (a) were prescribed any DMARD therapy for two consecutive months between July 1993 and February 1998, (b) were aged > or = 18 years, (c) had > or = 6 months of DMARD-free enrollment prior to the first DMARD, and (d) had a diagnosis of RA.

Results: The average age of the cohort (n = 571) was 51 years, and 70% were women.

Short report: migration among persons living with HIV.

Data from the first national probability sample of persons with HIV, the HIV Cost of Services and Utilization Survey (HCSUS), are used to examine migration patterns among persons with HIV/AIDS in the USA. Persons with serious illness may choose to relocate to receive better care or support. This migration has implications for the distribution of resources.

Where to seek care: an examination of people in rural areas with HIV/AIDS.

Though HIV/AIDS has spread to rural areas, little empirical evidence is available on where patients living in these areas receive care. This article presents estimates of rural residents in care for HIV/AIDS, their demographic and health-related characteristics, information about whether they receive care in a rural or urban setting, and data on the drug therapies prescribed. The estimates come from the HIV Cost and Services Utilization Study (HCSUS), a nationally representative probability sample of HIV-infected adults receiving care in the contiguous United States.

The economics of daily dialysis.

Research suggests that daily hemodialysis improves clinical outcomes and patient quality of life when compared with conventional hemodialysis; however, little is known about its economic impact. In this article, we review the literature on the costs of daily hemodialysis (n = 170). We also present updated results from an economic model we constructed that compares 1-year treatment costs for short daily in-center, short daily at-home, nocturnal, and conventional hemodialysis.

Vulnerability of rural hospitals to Medicare outpatient payment reform.

Because the Balanced Budget Act (BBA) of 1997 requires implementation of a Medicare prospective payment system (PPS) for hospital outpatient services, the authors evaluated the potential impact of outpatient PPS on rural hospitals. Areas examined include: (1) How dependent are rural hospitals on outpatient revenue? (2) Are they more likely than urban hospitals to be vulnerable to payment reform? (3) What types of rural hospitals will be most vulnerable to reform? Using Medicare cost report data, the authors found that small size and government ownership are more common among rural than urban hospitals and are the most important determinants of vulnerability to payment reform.

Patterns of disease-modifying antirheumatic drug use, medical resource consumption, and cost among rheumatoid arthritis patients.

We compared medical resource use and costs among rheumatoid arthritis (RA) patients receiving alternative disease-modifying antirheumatic drugs (DMARDs). The cohort study used data from a managed care organization. Health plan members who were prescribed DMARD therapy for at least 2 consecutive months, were age 18 years or older, had at least 6 months of DMARD-free enrollment prior to the first DMARD, and had a diagnosis of RA before or during the first month of DMARD were eligible.

Cost-effectiveness of Prosorba column therapy for rheumatoid arthritis: a framework for analysis.

Apheresis with the Prosorba column is safe and effective for treating refractory rheumatoid arthritis. It also is resource intensive. Economic evaluation of Prosorba column therapy could help promote efficient use of this technology.

The severely to profoundly hearing-impaired population in the United States: prevalence estimates and demographics.

This study informs policy makers and third-party payers of the prevalence and characteristics of the severely to profoundly hearing-impaired population in the United States. Nationally representative data were used for estimations in consultation with an expert advisory panel. The prevalence of severe to profound hearing impairment among the US population ranges from 464,000 to 738,000, with 54 percent of this population over age 65 years.

Costs of managing Helicobacter pylori-infected ulcer patients after initial therapy.

Background: The objective of this research was to evaluate the outcomes and costs of alternative approaches to managing patients previously treated for peptic ulcer disease and Helicobacter pylori infection.

Materials And Methods: A decision-analytic model was used to compare (1a) urease breath testing (UBT) for assessment of H. pylori status versus (1b) observation without further testing or treatment, among patients who were symptom-free following initial antimicrobial and antisecretory therapy for endoscopically demonstrated ulcer and H.

The case for daily dialysis: its impact on costs and quality of life.

Research suggests daily hemodialysis may improve clinical outcomes. To date, a comprehensive review of its implications on quality of life has not been performed, and little is known about its economic impact. We conducted an economic evaluation comparing short daily or nocturnal hemodialysis with thrice-weekly conventional in-center dialysis.

The concentration of health care expenditures, revisited.

In two previous publications, we described the distribution of health care expenditures among the civilian, noninstitutionalized U.S. population, specifically in terms of the share of aggregate expenditures accounted for by the top spenders in the distribution.

Medicare physician payment changes: impact on physicians and beneficiaries.

The Balanced Budget Act (BBA) of 1997 generally reduced Medicare payments for surgical services while increasing them for other services. Concern about implications of these fee reductions prompted the Medicare Payment Advisory Commission to sponsor a national survey of physicians to learn their views on Medicare payment and whether access to care has changed for Medicare beneficiaries. Results suggest that beneficiaries' access to care has not declined.

Unmet need for eyeglasses: results from the 1994 Robert Wood Johnson Access to Care Survey.

Background: Although poor access to general medical care services has been documented widely, the unmet need for supplemental health care services--such as eyeglasses--has been largely ignored. This article documents the inability to obtain eyeglasses on the national level and for various subpopulations using the 1994 Robert Wood Johnson Foundation National Access to Care Survey.

Methods: The Survey, a followup to the 1993 National Health Interview Survey, collected data on respondents' inability to obtain health care services due to access barriers.

Why primary care physicians join HMOs.

Objective: To determine the reasons why primary care physicians affiliate with health maintenance organizations (HMOs) and assess how these reasons vary with personal and practice characteristics.

Study Design: A 1996 national telephone/mail survey of primary care physicians who were affiliated with at least 1 HMO plan for more than 9 months.

Methods: Survey responses were assessed according to geographic region, age, income, level of involvement in managed care, and HMO penetration rate.

A worldwide assessment of medical journal editors' practices and needs--results of a survey by the World Association of Medical Editors.

Objectives: To identify editors interested in participating in a global organisation and communication network of medical editors; to assess current use of the peer-review process; and to determine current computer capabilities, needs, and interests of medical journal editors around the world.

Design: Mail survey of senior editors at 727 medical journals.

Setting: Fifty-seven countries worldwide.

Attitudes toward cost-containment features of managed care: differences among patient subgroups.

Objective: To analyze the extent to which personal characteristics and circumstances affect attitudes toward cost-containment aspects of managed care.

Study Design: A national probability sample component of the 1994 Robert Wood Johnson Foundation National Access to Care Survey.

Methods: Telephone and in-person survey follow-up of 3480 persons who completed the 1993 National Health Interview Survey.

Impact of the BBA on Medicare HMO payments for rural areas.

The Balanced Budget Act (BBA) of 1997 radically changed the way Medicare risk plans are paid, replacing the adjusted average per capita cost (AAPCC) system with one in which county payment rates are set as the highest of (1) a local/national blended rate; (2) a national payment floor; or (3) a 2 percent minimum update from the prior year's rate. This DataWatch presents results of simulations of the likely impact of these changes throughout the BBA implementation period ending in 2003. The assessment considers urban/rural differences in payment levels, year-to-year rate volatility, the types of rates paid, and budget-neutrality issues.

Access to dental care in the United States.

The authors analyzed data from the 1994 National Access to Care Survey and estimated the extent of dental care wants in the U.S. population and in various population subgroups.

Hospital-physician arrangements and hospital financial performance.

Objectives: The introduction of the Medicare Prospective Payment System and the more recent rise of managed care plans have greatly increased the importance of effective hospital financial management. Because physicians play a central role in directing hospital resource use, policies to influence physician behavior and to align physician and hospital interests more effectively are being advocated increasingly. This article evaluates the effect of nine strategies to facilitate physician involvement and integration into the hospital on hospital financial performance.

Primary care case management for Medicaid recipients: evaluation of the Maryland Access to Care program.

A growing number of states are implementing Medicaid managed care programs, and primary care case management (PCCM) is an important component of many of these systems. In this paper, we present results of an evaluation of one such PCCM program--the Maryland Access to Care (MAC) program. The evaluation uses five years of Medicaid claims and eligibility data from the period before and after the program's introduction to determine the program's impact on expenditures and service utilization.

Profiling resource use by primary-care practices: managed Medicare implications.

Variations in elderly Medicare beneficiaries' health service use are examined using a 100-percent sample of fee-for-service (FFS) claims data from Alabama, Iowa, and Maryland. Provider specialty, group practice type, practice size, and location are found to be significant factors affecting hospital and ambulatory care utilization and cost, after controlling for patient and regional characteristics. These results provide insights into utilization and cost expectations from different types of primary-care gatekeepers as the Medicare managed care market develops.

Use of alternative therapies: estimates from the 1994 Robert Wood Johnson Foundation National Access to Care Survey.

This study sought to update national estimates of the use of alternative therapies, to improve the quality of those estimates, and to examine differences between users and nonusers of alternative medicine. Data were analyzed from the general probability sample (N = 3450) of the 1994 Robert Wood Johnson Foundation National Access to Care Survey. The results indicate that nearly 10% of the U.

Pneumococcal pneumonia and influenza vaccination: access to and use by US Hispanic Medicare beneficiaries.

Objectives: This study examined differences between elderly Hispanic Medicare beneficiaries and other Medicare beneficiaries in the probability of being immunized for pneumococcal pneumonia and influenza.

Methods: We used the 1992 national Medicare Current Beneficiary Survey to evaluate influenza and pneumococcal pneumonia immunization rates.

Results: Elderly Hispanic Medicare beneficiaries were less likely than non-Hispanic White Medicare beneficiaries to have received an influenza vaccine in the past year or to have ever been immunized for pneumococcal pneumonia.