For over a decade, New York State has used hospital rate regulation (the New York Prospective Hospital Reimbursement Methodology [NYPHRM]) as a policy tool to achieve three objectives: containing costs, supporting financially stressed hospitals, and financing access to care for the uninsured. This case study of NYPHRM suggests that the regulatory approach, if pursued with vigor, can achieve any...

Arkansas implemented a primary-care case-management program in February 1994. This study evaluates the program during its first 17 months. Using quarterly data collected for the Health Care Financing Administration (HCFA), a pooled cross-sectional time series analysis (1991:4-1995:2) estimates the effect of eligibles' program enrollment on expenditure (total, inpatient hospital, outpatient hosp...

This article, adapted from a summary of the 1983 Annual Reports of the Medicare Boards of Trustees, presents the present and projected future actuarial status of the Hospital Insurance (HI) and Supplementary Medical Insurance (SMI) Trust Funds following the enactment of the Tax Equity and Fiscal Responsibility Act of 1982 and the Social Security Amendments of 1983. Although the Trustees charact...

When the Health Care Financing Administration implemented the Medicare prospective payment system (PPS), several types of hospitals and hospital units were excluded from the new reimbursement system, and they remained under the reasonable cost reimbursement system, subject to the target rate of increase limits. The implementation of PPS has been accompanied by several changes in hospital classi...

THE AMENDMENTS TO THE Social Security .1ct passed in 1967 (Public Law 90-248) made several changes in the old-age, survivors, disability, hospital, and supplementary medical insurance system.’ Some of these changes affected significantly the actuarial status of the system. The principles used to determine tile financing stability of the program were not altered, however. This article discusses ...

Little is known about the incidence and cost of injuries for Medicaid children. This article provides data on hospital utilization and payments for injuries among Medicaid children, using the Health Care Financing Administration's (HCFA) State Medicaid Research Files. During 1992, there were nearly 17,000 injury hospitalizations for California's Medicaid children (758 per 100,000 enrollees), re...

For the first 4 years of Medicare's prospective payment system (PPS), one national market basket of cost weights and price proxies has been used to update payment rates. Previous evidence for a single rate is reviewed, and more recent data are presented that show definite regional differences in input price inflation, resulting in systematic gains or losses for some regions. However, as long as...

The assumption that remittances are a substitute for credit has been an implicit or explicit theoretical foundation of many empirical studies on remittances. This paper directly tests this assumption by comparing the response to health-related shocks among national and transnational households using panel data from Mexico for 2002 and 2005. While the occurrence of serious health shocks that req...

This issue of Health Care Financing Review is devoted entirely to the accuracy of hospital case-mix measurement systems for reimbursing hospitals. We have brought together eight articles by active workers in this field, representing the most promising efforts to improve case-mix measurement. Although severity of illness is an organizing theme for these articles, their scope is much broader. The...

Objective To study population-level determinants of caesarean section trends in developed countries. Data sources/study setting National-level data (1980-2004) from developed countries on trends and potential determinants of caesarean section utilization. Study design The effect of maternal mortality, national income, hospital infrastructure and the health system financing and human resources p...