scholarly journals HMOs and Fee-For-Service Health Care Expenditures: Evidence from Medicare

10.3386/w5360 ◽  
1995 ◽  
Author(s):  
Laurence Baker
Keyword(s):  
Health Care ◽  
Health Care Expenditures ◽  
Fee For Service

The Oncology Care Model: A Critique

2016 ◽  
pp. e109-e114 ◽  
Author(s):  
Christian A. Thomas ◽  
Jeffrey C. Ward
Keyword(s):  
Health Care ◽  
Health Care Expenditures ◽  
Critical Discussion ◽  
Cost Of Care ◽  
Fee For Service ◽  
Care Model ◽  
Patient Admissions ◽  
Pilot Model ◽  
Oncology Care ◽  
The Cost

Rapidly increasing national health care expenditures are a major area of concern as threats to the integrity of the health care system. Significant increases in the cost of care for patients with cancer are driven by numerous factors, most importantly the cost of hospital care and escalating pharmaceutical costs. The current fee-for-service system (FFS) has been identified as a potential driver of the increasing cost of care, and multiple stakeholders are interested in replacing FFS with a system that improves the quality of care while at the same time reducing cost. Several models have been piloted, including a Center for Medicare & Medicaid Innovation (CMMI)–sponsored medical home model (COME HOME) for patients with solid tumors that was able to generate savings by integrating a phone triage system, pathways, and seamless patient care 7 days a week to reduce overall cost of care, mostly by decreasing patient admissions to hospitals and referrals to emergency departments. CMMI is now launching a new pilot model, the Oncology Care Model (OCM), which differs from COME HOME in several important ways. It does not abolish FFS but provides an additional payment in 6-month increments for each patient on active cancer treatment. It also allows practices to participate in savings if they can decrease the overall cost of care, to include all chemotherapy and supportive care drugs, and fulfill certain quality metrics. A critical discussion of the proposed model, which is scheduled to start in 2016, will be provided at the 2016 American Society of Clinical Oncology (ASCO) Annual Meeting with practicing oncologists and a Centers for Medicare & Medicaid Services (CMS) representative.

scholarly journals Managed Care and Health Care Expenditures: Evidence from Medicare, 1990-1994

1998 ◽  
Vol 1 (1) ◽  
Author(s):  
Laurence C. Baker ◽  
Sharmila Shankarkumar
Keyword(s):  
Health Care ◽  
Managed Care ◽  
Market Share ◽  
Health Care Policy ◽  
Care Delivery ◽  
Health Care Expenditures ◽  
Spillover Effects ◽  
Fee For Service ◽  
Health Care Market ◽  
Care Activity

Increases in the activity of managed care organizations may have "spillover effects," influencing the entire health care delivery system's performance, so that care for both managed-care and non–managed-care patients is affected. Some proposals for Medicare reform have incorporated spillover effects as a way that increasing Medicare HMO enrollment could contribute to savings for Medicare.This paper investigates the relationship between HMO market share and expenditures for the care of beneficiaries enrolled in traditional fee-for-service Medicare. We find that increases in systemwide HMO market share (which includes both Medicare and non-Medicare enrollment) are associated with declines in both Part A and Part B fee-for-service expenditures. The fact that managed care can influence expenditures for this population, which should be well insulated from the direct effects of managed care, suggests that managed-care activity can have broad effects on the entire health care market. Increases in Medicare HMO market share alone are associated with increases in Part A expenditures and with small decreases in Part B expenditures. This suggests that any spillovers directly associated with Medicare HMO enrollment are small.For general health care policy discussions, these results suggest that assessment of new policies that would influence managed care should account not only for its effects on enrollees but also for its systemwide effects. For Medicare policy discussions, these findings imply that previous results that seemed to show large spillover effects associated with increases in Medicare HMO market share, but inadequately accounted for systemwide managed-care activity and relied on older data, overstated the magnitude of actual Medicare spillovers.

scholarly journals Physician Beliefs and Patient Preferences: A New Look at Regional Variation in Health Care Spending

2019 ◽  
Vol 11 (1) ◽  
pp. 192-221 ◽  
Author(s):  
David Cutler ◽  
Jonathan S. Skinner ◽  
Ariel Dora Stern ◽  
David Wennberg
Keyword(s):  
Health Care ◽  
End Of Life Care ◽  
Clinical Evidence ◽  
Organizational Factors ◽  
Health Care Expenditures ◽  
Fee For Service ◽  
Physician Supply ◽  
Considerable Controversy ◽  
Physician Beliefs ◽  
Supply Side Factors

There is considerable controversy about the causes of regional variations in health care expenditures. Using vignettes from patient and physician surveys linked to fee-for-service Medicare expenditures, this study asks whether patient demand-side factors or physician supply-side factors explain these variations. The results indicate that patient demand is relatively unimportant in explaining variations. Physician organizational factors matter, but the most important factor is physician beliefs about treatment. In Medicare, we estimate that 35 percent of spending for end-of-life care and 12 percent of spending for heart attack patients (and for all enrollees) is associated with physician beliefs unsupported by clinical evidence. (JEL D83, H75, I11, I18)

Systematic review of factors determining health care expenditures

2021 ◽  
Author(s):  
Mohammad Meskarpour Amiri ◽  
Mahmood Kazemian ◽  
Zahra Motaghed ◽  
Zhaleh Abdi
Keyword(s):  
Systematic Review ◽  
Health Care ◽  
Health Care Expenditures
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