Health Care and Financing Review: Web Exclusives

The following articles are web exclusives to the Health Care and Financing Review:

Clinician Feedback on Using Episode Groupers with Medicare Claims Data

Fred Thomas, Ph.D., Craig Caplan, M.A., Jesse M. Levy, Ph.D., Marty Cohen, M.P.A., James Leonard, M.P.H., Todd Caldis, Ph.D., and Curt Mueller, Ph.D.

CMS is investigating techniques that might help identify costly physician practice patterns. One method presently under evaluation is to compare resource use for certain episodes of care using commercially available episode grouping software. Although this software has been used by the private sector to classify insured individuals' medical claims into episodes of care, it has never been used with fee-for-service Medicare claims except in the studies by the Medicare Payment Advisory Commission (MedPAC) and CMS. This study reviews and reports on clinician feedback on the most obvious and important decisions that must be faced by Medicare to use grouped claims data as the foundation for a physician performance measurement system. The panel reactions show the importance of bringing persons with clinical knowledge into the development process. The clinician feedback confirms that additional research is needed. To review the article, please click on the link in the "Downloads" section below.

Financing Health Care: Businesses, Households, and Governments, 1987-2003

Cathy A. Cowan, M.B.A. and Micah B. Hartman

This article provides estimates of health care expenditures by businesses, households, and governments for 1987-2003. Sponsors that finance public and private health insurance programs and other payers face increasing challenges as health care cost rise. Their capacity to support rising costs was particularly strained during the recent economic recession, with the Federal Government's burden measured against revenue available for this purpose growing faster than for other sponsors. To review the article, please click on the link in the "Downloads" section below.

Age Estimates in the National Health Accounts

Sean P. Keehan, M.A., Helen C. Lazenby, Mark A. Zezza, M.A., and Aaron C. Catlin, M.S.M.

This article presents historical trends of health spending by age. Personal health care is broken out into seven age groups for 1987, 1996, and 1999. Analysis of trends in health care spending is provided separately for children (age 0-18), working-age adults (age 19-64), and the elderly (age 65 or over). Future impacts of aging are also discussed, including using the historical estimates in a simulation to show only the effect of changing the age mix of the population over the next 50 years.  To review the article, please click on the link in the "Downloads" section below.