The possibility of health care reform has helped focus attention on equity in the receipt of health care. This is a particular issue for the Medicaid program, as State variations in eligibility and payment policies have historically created inequity. This study examines equity for Medicaid beneficiaries and State taxpayers during the latter 1980s. Findings indicate that federally mandated expan...

Faced with declining payment rates, California providers have implemented various strategies that have strengthened their leverage in negotiating prices with private health plans. When negotiating together, hospitals and physicians enhance their already significant bargaining clout. California's experience is a cautionary tale for national health reform: It suggests that proposals to promote in...

The paper presents a stylised model of contracting for a specific health service. The benefit of this service differs across patients. A purchaser, National Health Service (NHS, insurer) offers a contract to providers (hospitals, GP's), under the constraint of limited information about the provider's costs and the contract specifies the payment as a function of the number of cases treated. A nu...

Health care payers have implemented pay-for-performance contracts without explicit characterization of the underlying quality problem or an understanding of the interaction between pay-for-performance and existing payment mechanisms. In this paper, ine cient quality of health care services stems from di culty consumers have in observing some aspects of quality. Traditional health care payment s...

In a recently concluded Medicare demonstration, Community Nursing Organizations (CNOs) received capitated payment to provide a subset of Medicare services through a nursing case management delivery system. Demonstration participation was voluntary, both for CNOs and recruited beneficiaries, raising several challenging issues associated with selection. We investigate provider and beneficiary sel...

Public health efforts to reduce maternal complications and poor pregnancy outcomes encompass a wide array of approaches, including close attention to the system of perinatal health care, particularly its organization and financing. Historically, strategies to regionalize or coordinate the system of perinatal care services were developed to improve perinatal outcomes while maximizing the efficie...

Comparative effectiveness research has been promoted as a way to control health care costs, but there has been less discussion of the mechanisms through which new evidence actually will influence physician practice, patient preference, and manufacturer investment. Public and private insurers use conditional coverage, consumer cost sharing, provider contracting, and drug payment policies to mana...

This paper explores the causes of the dramatic rise in total Medicare home health spending under the prospective payment system. In 2000, Medicare home health care introduced the prospective payment system to control the spending growth that had occurred under the fee-for-service payment system. However, total spending under the new system has continued to increase significantly. I examine the ...

This paper develops a simple model of payment incentives and empirically evaluates provider payment reform in Hainan Province, China. We use a pre-post study design with a control group to analyse two years of claims data to assess the impact of a January 1997 change to prospective payment for a sub-sample of the hospitals. This difference-in-difference empirical strategy allows us to isolate t...

To illuminate Medicaid's growing role as a health care purchaser, we estimated Medicaid spending and market shares for 30 markets defined by provider category of service. For approximately 15 markets, our estimates are more detailed than the data available from standard sources. Two-thirds of Medicaid spending occurs in markets where the program has a modest market share. The other one-third oc...