CONTEXT Few studies have compared patterns of care in health maintenance organization (HMO) and fee-for-service (FFS) settings. OBJECTIVE To examine breast cancer stage at diagnosis and, for those at an early stage, treatment patterns for elderly women in HMO and FFS settings. DESIGN Cancer registry data from the Surveillance, Epidemiology, and End Results (SEER) program linked to Medicare ...

Medical expenditures in workers' compensation programs have been subjected to few cost containment strategies. As workers' compensation costs have escalated, however, increasing attention is being given to the role of medical fee schedules in containing the prices of medical services. To this end, we develop a model for estimating the potential cost savings from implementing medical fee schedul...

BACKGROUND There is concern that care provided in the Veterans Health Administration (VA) may be of poorer quality than non-VA health care. We compared use of medications after acute myocardial infarction in the VA with that in non-VA healthcare settings under fee-for-service (FFS) Medicare financing. METHODS AND RESULTS We used clinical data from 2486 VA and 29 249 FFS men >65 years old disc...

BACKGROUND Reform of health services has given primary care facilities increased responsibility for patients with serious mental disorders (SMD). There has also been a growing awareness of the high somatic morbidity among SMD patients, an obvious challenge for general practitioners (GPs). The aim of this study was to assess the utilisation of GP services by patients with schizophrenia. METHOD...

This retrospective study describes healthcare resource utilization (HRU) and cost of care, by line therapy (LOT), in Medicare Fee-for-Service (FFS) beneficiaries diagnosed with mCRPC initiating systemic treatment. A cohort was conducted using the 100% sample FFS medical, pharmacy, enrollment data. Male were included if: a) initiated between January 1, 2015 September 30, 2019 (index date: treatm...

This issue focuses on selected developments in the Medicare fee-for-service program. Two of the articles provide new estimates of the effect of Medicare supplemental insurance on total Medicare utilization and costs: One addresses utilization differences under alternative forms of supplemental insurance, and the other reports on utilization experience under the Medicare SELECT Demonstration. Tw...

OBJECTIVE To compare the continuity of care experienced by children who are in foster care with that of children who are not in foster care and are covered under Medicaid managed care and Medicaid fee-for-service (FFS). METHODS This retrospective cohort study used Medicaid claims/encounter data from Washington state. A total of 903 children who were in foster care and continuously enrolled in...

BACKGROUND Rates of inpatient care for mental health and substance abuse treatment have been reported to fall after the introduction of managed care, but the actual decline may be overstated. Almost all managed care impact studies are based on pre-post comparisons, which have two drawbacks: secular downward trends may be attributed to a managed care effect and self-selection may exaggerate the ...

Medicare health maintenance organization (HMO) enrollees use more preventive care services than their fee-for-service (FFS) counterparts. This may be because those who enroll in HMOs have characteristics that make them more disposed to use preventive care. To investigate this possibility, we examined the use of four preventive care services by respondents to the 1996 Medicare Current Beneficiar...

BACKGROUND As healthcare spending continues to increase, medical insurance is now under great pressure of growing economic burden. To control the excessive growth of medical expenditure, change of medical payment system was clearly put forward in China's new healthcare reform. With this end, Tianjin, a large city in North China, is now exploring to replace traditional fee-for-service (FFS) with...