Suchergebnisse

The interim payment system (IPS) for Medicare home health services, enacted in the Balanced Budget Act of 1997, was intended to slow the growth of home health expenses until HCFA could design a new prospective system. Instead, the IPS has acted like a per-case payment system without case-mix adjustment. Its impact on agencies, along with other policy pressures, has been first to slow and then to reverse the dramatic expansion of the home health sector. In this paper, we identify the impetus for payment changes in the recent history of the Medicare home health benefit. We then present emerging evidence about the effects of IPS and other recent policies on home health. Finally, we draw several lessons from this experience for the impending prospective payment system.

Using pharmacy benefits manager claims data, this study analyzed how cost-management techniques including cost sharing affected enrollees in health maintenance organizations (HMOs) versus employer-sponsored fee-for-service plans. Because HMOs bear the risk of pharmaceutical costs and influence the prescribing practices of the physicians in their network, we expected different patterns of prescription use, such as proportionately more generic medications in HMOs. Also, because HMO physicians are likely to prescribe relatively more drugs for high-severity conditions, HMO enrollee demand should be less price sensitive. The impact of cost sharing was found to be significantly less for HMOs. A 5-dollar increase in copayments decreased expenditures by 16 percent in fee-for-service plans but only by 1 percent in HMOs. Furthermore, when cost sharing was set at zero, HMO plans were found to have significantly fewer and cheaper medications, resulting in lower per-enrollee medication expenditures.