OBJECTIVES To compute a benchmark for tracking readmission rates among patients enrolled in Medicare's private comprehensive Medicare Advantage (MA) plans and to develop preliminary comparisons with the fee-for-service (FFS) readmission rates. STUDY DESIGN Descriptive data presentation with analytic discussion. METHODS We computed a benchmark for rehospitalization rates among MA patients us...

OBJECTIVES To assess differences in services associated with mental health status and prescriptions among Medicaid patients diagnosed with diabetes mellitus. DESIGN Secondary data analyses of South Carolina (SC) Medicaid enrollees. PARTICIPANTS SC Medicaid enrollees with a diagnosis of diabetes mellitus (N = 555) continuously enrolled in either managed care (MC) or fee for service (FFS) pro...

OBJECTIVE To compare the clinical quality of care between Medicare fee-for-service (FFS) and Medicare Advantage (MA) programs. METHODS We compared 11 Healthcare Effectiveness Data and Information Set (HEDIS) quality measures nationwide for MA managed care plans and the FFS program in 2006 and 2007. We adjusted FFS measures to match the geographic distribution of MA. RESULTS Medicare Advanta...

BACKGROUND The World Health Organization calls for more work evaluating the effect of health care reforms on gender equity in developed countries. We performed this evaluation in Ontario, Canada where primary care models resulting from reforms co-exist. METHODS This cross sectional study of primary care practices uses data collected in 2005-2006. Healthcare service models included in the stud...

PURPOSE As an alternative to the existing fee-for-service (FFS) system, a diagnosis-related group (DRG)-based payment system has been suggested. The aim of this study was to investigate the early results of pediatric appendicitis treatment under the DRG system, focusing on health care expenditure and quality of health care services. PATIENTS AND METHODS The medical records of 60 patients, 30 ...

BACKGROUND The purpose of this study is to analyze the relationship between newly introduced primary care models in Ontario, Canada, and patients' primary care and total health care costs. A specific focus is on the payment mechanisms for primary care physicians, i.e. fee-for-service (FFS), enhanced-FFS, and blended capitation, and whether providers practiced as part of a multidisciplinary team...

This study examines the patterns of length of stay (LOS) and inpatient costs for both Medicaid managed care and nonmanaged care patients using data from Medicaid patients aged 18 to 64 years who were discharged from hospitals in Florida between 2006 and 2012. This study used pooled cross-sectional multilevel modeling. The results show that the type of Medicaid program in which patients were enr...