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HOSPITAL COST CONTROL IMPACTS ON THE POOR AND UNINSURED

医院成本控制对穷人和未参保人群的影响

基本信息

批准号：
3371524
负责人：
David Salkever
金额：
$ 24.08万
依托单位：
JOHNS HOPKINS UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
1986
资助国家：
美国
起止时间：
1986-09-30 至 1989-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/3371524
关键词：
decision making health care cost /financing health care service availability health care service utilization health related legal hospital utilization managed care medical indigency

项目摘要

Our objective is to assess and compare the effects of cost control strategies, including Medicaid payment restrictions. State rate-setting and HMOs, on access to and use of inpatient and ambulatory hospital care by the poor and uninsured. These effects will be measured using data for 1976-1984 from the National Health Interview Survey and Hospital Discharge Survey. Specific aims to be addressed are: (1) Examine changes over time in access to hospital care among individuals with low incomes and assess the influence of provider, regulatory and financing characteristics on receipt of hospital services and level of use. (2) Among Medicaid eligibles, examine the impact of changes over time and across states im Medicaid eligibility and benefit structure on the receipt of hospital services and level of use. (3) Among individuals with low incomes who are uninsured, determine the extent to which access to ambulatory and inpatient services has declined, and the extent to which state policies toward indigent care have attenuated the effects of cost containment efforts. As a complement to the population-based analysis of access and use, hospital behavior relative to cost control and uncompensated care will be examined. Specifically, survey and financial report data will be used to estimate models of hospital behavior relative to decisions to servie those with low incomes, and particularly those with no insurance. It is recognized that hospitals can take a variety of actions to limit the burden of uncompensated care, including screening admissions, collection efforts, closing departments or clinics that generate high levels of uncompensated care and transferring indigent patients to other institutions. Models will be estimated to examine the influence of cost containment and indigent care financing arrangements on these types of hospital decisions.

我们的目标是评估和比较成本的影响控制策略，包括医疗补助支付限制。国家费率制定和卫生组织，关于获得和使用住院和医院的流动医疗服务。这些将使用1976-1984年的数据来衡量影响，国民健康访问调查和出院调查. 具体目标如下： (1)审查在获得医院护理方面随着时间的变化，低收入的人，并评估接收时的供应商、监管和融资特征医院服务和使用水平。 (2)在医疗补助计划中，检查变化的影响随着时间的推移和各州的医疗补助资格和福利医院服务的结构和使用水平。 (3)在没有保险的低收入个人中，确定在何种程度上获得门诊和住院服务已经下降，在何种程度上，对贫困护理的政策削弱了成本控制措施。作为对基于人口的获取和使用服务分析的补充，使用，医院行为相对于成本控制和将审查无偿护理。具体而言，调查和财务报告数据将用于估计模型，医院的行为与决定为那些低收入人群，尤其是没有保险的人群。是认识到医院可以采取各种行动，限制无偿护理的负担，包括筛查入院，收集工作，关闭部门或诊所产生高水平的无偿护理，将贫困患者转移到其他机构。模型将估计审查成本控制的影响和贫穷的保健筹资安排，医院的决定