Hospital care for the "self-pay" patient

The number of hospitalized patients lacking an identifiable source of third-party payment has risen substantially in recent years. This study examines trends in the hospitalization of "self-pay" patients and investigates causal influences on the propensity of hospitals to accept such patients for treatment. Our analysis pays particular attention to the relationship between Medicare's prospective payment system (PPS) and hospitals' self-pay patient share. Our results show an overall increase in both the number and proportion of self-pay patients treated by hospitals between 1980 and 1985. Substantial differences existed among the types of hospitals that accepted such patients, with major teaching hospitals treating an increasingly disproportionate share. The mix of self-pay patients in terms of age, sex, and reason for hospitalization remained stable during the period under study. Our conclusion is that the regression analysis shows no evidence that PPS reduced hospitals' willingness to treat uninsured patients.     

Managing the NATO alliance: Congress and burdensharing

The Congress has been an active partner in the transatlantic alliance from the negotiation of the North Atlantic Treaty to the present day. Congressional perpectives have been substantially influenced by the desire to limit the U.S. share of the NATO burden. In recent years, U.S.—European differences over East—West relations, Third World security requirements, and other issues have intensified the burdensharng debate. Now some members of Congress are once again using the threat of unilateral U.S. troop withdrawals from Europe—the main source of congressional influence on the alliance—to pressure the Europeans to increase their defense efforts. Whether the recent focus on burdensharing will recede or grow in the next few years will depend on how the administration and the allies respond to the congressional pressure. In any case, Congress is likely to continue to insist on its due share of management rights in the NATO relationship.     

What is the HMO Act and what is its impact on employers?

The explosion in health care costs has spurred the development of Health Maintenance Organizations (HMOS). It is predicted that $180 billion will be spent on health care this year. The search for more economical alternatives to the traditional fee-for-service type of care has naturally focused attention on HMOs. Evidence indicates that the cost of HMO services can be one-fourth to one-third less than the cost of traditional care. Such figures make HMOs one of the most important, and least understood, topics confronting employers today.     

Cross-subsidies and payment for hospital care

This study uses hospital data from the 1979 American Hospital Association Reimbursement Survey in a multivariate framework to assess the impact of discounts and third-party reimbursement on hospital costs and profitability. Three central issues are addressed: (1) Is a differential payment justified for Medicare, Medicaid, and/or Blue Cross on the basis of differential costs? (2) Have the cost-containment efforts of the dominant payers reduced total payments to hospitals? and (3) What part of the overall savings in payments to hospitals is in the form of reduced costs rather than reduced profits? On the basis of the evidence in this study, we find (1) that the differential payment is not justified; (2) that the cost-containment efforts of the dominant payers have reduced total payments to hospitals somewhat, but a substantial amount of cost-shifting remains; and (3) that the savings is in profits, rather than in costs.     

Do juvenile drug courts reduce recidivism?: Outcomes of drug court and an adolescent substance abuse program

Juvenile drug courts have emerged as “innovative” responses to juvenile drug offenders, but comparatively little is known about their operations. This paper presents results of a retrospective comparison of drug court participants to an adolescent substance abuse program (ASAP) to examine which participants fared better in terms of future recidivism. Using data collected from official case files, we compared recidivism levels for all juveniles (n = 150) terminated from drug court between 1996 and 1999 with those of a random sample of juveniles (n = 158) terminated from ASAP during 1994 and 1995. Biand multivariate analyses were conducted to identify whether significant differences existed between the groups concerning re-arrest (recidivism) over a 24-month post-release observation period. Study results highlighted by logistic regression analyses suggesting that juveniles in drug court were no more likely to recidivate than were juveniles in ASAP is a positive finding for the drug court program and is an indication that the program is working, especially given the serious nature of this juvenile offender population.