Medicare Payment and Hospital Provision of Outpatient Care to the Uninsured

Objective. To describe the amount of hospital outpatient care provided to the uninsured and its association with Medicare payment rate cuts following the implementation of Medicare\u27s Outpatient Prospective Payment System. Data Sources/Study Setting. We use hospital outpatient discharge records from Florida from 1997 through 2008. Study Design. We estimate multivariate regression models of hospital outpatient care provided to the uninsured in separate samples of nonprofit and for-profit hospitals. Principal Findings. Hospital outpatient departments provide significant amounts of care to the uninsured. As Medicare payment rates fall, total charges and the share of charges for outpatient visits by the uninsured decrease at nonprofit hospitals. At for-profit hospitals, the share of outpatient care provided to uninsured patients increases, but there is no significant change in the number of uninsured discharges. Conclusions. Nonprofit and for-profit hospitals respond differently to reductions in Medicare payments; thus, studies of the impact of legislated Medicare payment cuts on care of the uninsured should account for differences in hospital ownership in communities. Given that outpatient care to the uninsured includes preventive and diagnostic care procedures, reductions in this care following payment cuts may adversely affect long-run health and health care costs in communities dominated by nonprofit hospitals

The Costs of Fall‐Related Injuries among Older Adults: Annual Per‐Faller, Service Component, and Patient Out‐of‐Pocket Costs

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/138392/1/hesr12554_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/138392/2/hesr12554.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/138392/3/hesr12554-sup-0001-Author.pd

Sustaining the future of HIV counselling to reach 90-90-90 : a regional country analysis

Introduction: Counselling services are recommended by the World Health Organization and have been partially adopted by national HIV guidelines. In settings with a high HIV burden, patient education and counselling is often performed by lay workers, mainly supported with international funding. There are few examples where ministries of health have been able to absorb lay counsellors into their health systems or otherwise sustain their work. We document the role of lay cadres involved in HIV testing and counselling and adherence support and discuss approaches to sustainability. Methods: We focused on a purposive sample of eight sub-Saharan African countries where Medecins Sans Frontieres supports HIV programmes: Guinea, Lesotho, Malawi, Mozambique, South Africa, Swaziland, Zambia and Zimbabwe. We reviewed both published and grey literature, including national policies and donor proposals, and interviewed key informants, including relevant government staff, donors and non-governmental organizations. Results and discussion: Lay counsellors play a critical role in scaling up HIV services and addressing gaps in the HIV testing and treatment cascade by providing HIV testing and counselling and adherence support at both the facility and community levels. Countries have taken various steps in recognizing lay counsellors, including harmonizing training, job descriptions and support structures. However, formal integration of this cadre into national health systems is limited, as lay counsellors are usually not included in national strategies or budgeting. Conclusions: The current trend of reduced donor support for lay counsellors, combined with lack of national prioritization, threatens the sustainability of this cadre and thereby quality HIV service delivery

The moral economy of the pharmaceutical industry: Legitimising prices

The practices of pharmaceutical companies have been widely criticised by researchers and investigative journalists, yet their conduct has mostly escaped significant moral opprobrium from the wider public, health professionals and governments. This article examines one reason for this by exploring the techniques companies use when seeking to justify and legitimise their conduct – legitimising techniques that help to render their failures to adhere to accepted standards less visible. It explores these techniques by examining four cases involving pricing where the companies’ conduct has, nonetheless, been questioned. It is divided into three parts. The first looks at the various publicly-stated standards that provide the moral context for the industry’s activities. The second examines four cases, each involving pricing, where companies’ prices have been challenged as morally unacceptable, each leading to a US Government investigation. These provide a means of exploring how companies seek to justify their actions in order to maintain the appearance of conformity to accepted moral standards. The third considers some reasons why the industry’s efforts at legitimation have considerable force. The analysis shows not only the character of the claims made by pharmaceutical companies in defence of their practices – claims about the health benefits of the medicine, access to it, and research and development costs, which are all often exaggerated. It also shows why the companies’ legitimising tactics are typically effective

Guiding of relativistic electron beams in dense matter by laser-driven magnetostatic fields

Intense lasers interacting with dense targets accelerate relativistic electron beams, whichtransport part of the laser energy into the target depth. However, the overall laser-to-targetenergy coupling efficiency is impaired by the large divergence of the electron beam, intrinsicto the laser-plasma interaction. Here we demonstrate that an efficient guiding ofMeV electrons with about 30MA current in solid matter is obtained by imposing a laserdrivenlongitudinal magnetostatic field of 600 T. In the magnetized conditions the transportedenergy density and the peak background electron temperature at the 60-μm-thicktarget's rear surface rise by about a factor of five, as unfolded from benchmarked simulations.Such an improvement of energy-density flux through dense matter paves the ground foradvances in laser-driven intense sources of energetic particles and radiation, driving matter toextreme temperatures, reaching states relevant for planetary or stellar science as yet inaccessibleat the laboratory scale and achieving high-gain laser-driven thermonuclear fusion