HOSPITAL COST CONTROL IMPACTS ON THE POOR AND UNINSURED

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。 关于住院病人的接触和使用的国家费率设定和医疗保健组织 以及由穷人和未参保者提供的非卧床医院护理。这些 影响将使用1976-1984年的数据来衡量， 全国健康访谈调查与医院出院 调查。需要解决的具体目标包括： (1)审查获得医院护理的机会随时间的变化 低收入的个人，并评估 收货时的供应商、监管和融资特征 医院服务和使用水平。 (2)在符合医疗补助条件的人中，检查变化的影响 随着时间的推移和各州的IM医疗补助资格和福利 关于接受医院服务的结构和使用水平。 (三)未参保的低收入个人， 确定可在多大程度上使用非卧床和 住院服务有所下降，州政府在多大程度上 针对贫困人口的护理政策削弱了 控制成本的努力。 作为对基于人口的可获得性和可及性分析的补充 使用，医院行为与成本控制和 将对无偿护理进行审查。具体地说，调查和 财务报告数据将用于估计以下模型 与决定为患者提供服务相关的医院行为 低收入者，尤其是那些没有保险的人。它是 认识到医院可以采取各种行动来 限制无偿护理的负担，包括筛查 入院、收集、关闭科室或诊所 产生了高水平的无偿护理和 将贫困患者转移到其他机构。模型 预计将检查成本控制的影响 和关于这些类型的贫困护理融资安排 医院的决定。

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.