O Programa Bolsa Família (PBF) instituído em 2001 no Brasil é o único programa de âmbito nacional para o enfrentamento das questões relacionadas ao estado nutricional das crianças. Embora venha se expandindo ano após ano, ainda são poucas as avaliações no que se refere à repercussão nas condições de saúde e nutrição da população. O objetivo deste estudo é verificar o impacto do PBF no estado nutricional das crianças beneficiárias. Método: Inicialmente foi realizado um estudo de revisão sistemática com o objetivo de obter informações do estado nutricional dos beneficiários. Na sequência por meio de levantamento de dados secundários do Sistema de Vigilância Alimentar e Nutricional (SISVAN) de Blumenau-SC foi realizado um estudo de coorte longitudinal, comparando a evolução do estado nutricional das crianças beneficiárias e não beneficiárias do Programa Bolsa Família, durante os anos de 2006 a 2008. Resultado: Em ambos os trabalhos pode-se verificar que os dados não permitem concluir se o PBF modificou ou não o estado nutricional dos beneficiários.; The ¨Bolsa Família¨ Program (PBF) established in 2001 is the only nationwide program for dealing with issues related to food and nutrition. Although it will be expanding...
OBJECTIVE: To estimate out-of-pocket health care spending by lower-income Medicare beneficiaries, and to examine spending variations between those who receive Medicaid assistance and those who do not receive such aid. DATA SOURCES AND COLLECTION: 1993 Medicare Current Beneficiary Survey (MCBS) Cost and Use files, supplemented with data from the Bureau of the Census (Current Population Survey); the Congressional Budget Office; the Health Care Financing Administration, Office of the Actuary (National Health Accounts); and the Social Security Administration. STUDY DESIGN: We analyzed out-of-pocket spending through a Medicare Benefits Simulation model, which projects out-of-pocket health care spending from the 1993 MCBS to 1997. Out-of-pocket health care spending is defined to include Medicare deductibles and coinsurance; premiums for private insurance, Medicare Part B, and Medicare HMOs; payments for non-covered goods and services; and balance billing by physicians. It excludes the costs of home care and nursing facility services, as well as indirect tax payments toward health care financing. PRINCIPAL FINDINGS: Almost 60 percent of beneficiaries with incomes below the poverty level did not receive Medicaid assistance in 1997. We estimate that these beneficiaries spent...
OBJECTIVE: To compare adjusted mortality rates of TEFRA-risk HMO enrollees and disenrollees with rates of beneficiaries enrolled in the Medicare fee-for-service sector (FFS), and to compare the time until death for decedents in these three groups. DATA SOURCE: Data are from the 124 counties with the largest TEFRA-risk HMO enrollment using 1993-1994 Medicare Denominator files for beneficiaries enrolled in the FFS and TEFRA-risk HMO sectors. STUDY DESIGN: A retrospective study that tracks the mortality rates and time until death of a random sample of 1,240,120 Medicare beneficiaries in the FFS sector and 1,526,502 enrollees in HMOs between April 1, 1993 and April 1, 1994. A total of 58,201 beneficiaries switched from an HMO to the FFS sector and were analyzed separately. PRINCIPAL FINDINGS: HMO enrollees have lower relative odds of mortality than a comparable group of FFS beneficiaries. Conversely, HMO disenrollees have higher relative odds of mortality than comparable FFS beneficiaries. Among decedents in the three groups, HMO enrollees lived longer than FFS beneficiaries, who in turn lived longer than HMO disenrollees. CONCLUSIONS: Medicare TEFRA-risk HMO enrollees appear to be, on average, healthier than beneficiaries enrolled in the FFS sector...
OBJECTIVES: To assess which Consumer Assessment of Health Plans (CAHPS) survey measures Medicare beneficiaries find the most meaningful, how beneficiaries and information intermediaries interpret different formats for presenting CAHPS information, and how beneficiaries have reacted to the CAHPS information included in the annual mailing to beneficiaries called Medicare & You 2000. DATA SOURCES: Fourteen focus groups of beneficiaries and State Health Insurance Assistance Program counselors, more than 200 cognitive interviews, and 122 mall-intercept interviews with beneficiaries were conducted from spring 1998 through winter 2000. STUDY DESIGN: In 1998 focus groups and cognitive interviews were conducted with Medicare beneficiaries and State Health Insurance Assistance Program counselors to determine which CAHPS measures to report to Medicare beneficiaries and how to report this information. In 1999 additional focus groups and mall-intercept interviews were conducted to determine which measures to include in Medicare & You 2000. To obtain feedback on the CAHPS information in Medicare & You 2000 additional focus groups were conducted in winter 2000. PRINCIPAL FINDINGS:Focus group participants indicated that getting the care they need quickly...
OBJECTIVES: This study examined differences between elderly Hispanic Medicare beneficiaries and other Medicare beneficiaries in the probability of being immunized for pneumococcal pneumonia and influenza. METHODS: We used the 1992 national Medicare Current Beneficiary Survey to evaluate influenza and pneumococcal pneumonia immunization rates. RESULTS: Elderly Hispanic Medicare beneficiaries were less likely than non-Hispanic White Medicare beneficiaries to have received an influenza vaccine in the past year or to have ever been immunized for pneumococcal pneumonia. Speaking Spanish was statistically significantly associated with influenza vaccination but not with pneumococcal pneumonia vaccination. Supplemental insurance status, HMO enrollment, having a usual source of care, and being satisfied with access to care were positively associated with immunization. CONCLUSIONS: Strategies that may improve immunization rates among elderly. Hispanics include reducing the inconvenience of being immunized, decreasing out-of-pocket costs, linking beneficiaries with providers, and educating Hispanic beneficiaries in Spanish about the benefits of vaccinations.
Despite extensive use of prescription medications in ESRD, relatively little is known about the participation of Medicare ESRD beneficiaries in the Part D program. Here, we quantitated the sources of drug coverage among ESRD beneficiaries and explored the Part D plan preferences of ESRD beneficiaries with regard to deductibles, coverage gaps, and monthly premiums. We obtained data on beneficiary sources of creditable coverage, characteristics of Part D plans, demographics, and residence from the Centers for Medicare and Medicaid Chronic Condition Data Warehouse and identified beneficiaries with ESRD from the US Renal Data System. We found that a substantial proportion (17.0%) of ESRD beneficiaries lacked a known source of creditable drug coverage in 2007 and 64.3% were enrolled in Part D. Of those enrolled, 72% received the Medicare Part D low-income subsidy. ESRD beneficiaries who enrolled in standalone Part D plans without the assistance of the low-income subsidy tended to prefer more comprehensive coverage options. In conclusion, more outreach is needed to ensure that beneficiaries who lack coverage obtain the coverage they need and that ESRD beneficiaries join the best plans for managing their disease and accompanying comorbid conditions.
Given Medicare’s recent national coverage decision on bariatric surgery, as well as potential coverage expansions for other obesity-related treatments, data on obesity in the Medicare population have great relevance. Using nationally representative data, we estimate that between 1997 and 2002, the prevalence of obesity in the Medicare population increased by 5.6 percentage points, or about 2.7 million beneficiaries. By 2002, 21.4 percent of aged beneficiaries and 39.3 percent of disabled beneficiaries were obese, compared with 16.4 percent and 32.5 percent, respectively, in 1997. Using 2002 data, we estimate that three million beneficiaries would be eligible for bariatric surgery coverage under current Medicare policy.
This article examines geographic differences in the use of mental health services among Aid to Families with Dependent Children (AFDC)-eligible Medicaid beneficiaries in Maine. Findings indicate that rural AFDC beneficiaries have significantly lower utilization of mental health services than urban beneficiaries. Specialty mental health providers account for the majority of ambulatory visits for both rural and urban beneficiaries. However, rural beneficiaries rely more on primary-care providers than do urban beneficiaries. Differences in use are largely explained by variations in the supply of specialty mental health providers. This finding supports the long-held assumption that lower supply is a barrier to access to mental health services in rural areas.
Efforts to study racial variations in access to health care for minorities other than black persons have been hampered by a paucity of data. The Health Care Financing Administration (HCFA) has made efforts in the past few years to enhance the racial codes on the Medicare enrollment files to include Hispanic, Asian American, and Native American designations. This study examines hospitalization rates by these more detailed racial/ethnic groupings. The results show black, Hispanic, and Native American aged beneficiaries compared with white beneficiaries have higher hospitalization rates. Asian American beneficiaries have lower hospitalization rates. Rates of revascularization—coronary artery bypass graft (CABG) and percutaneous transluminal coronary angioplasty (PTCA)—are lower for black, Hispanic, and Native American beneficiaries compared with white beneficiaries, while rates for Asian Americans are similar to rates for white beneficiaries.
The Medicare+Choice (M+C) program has faced successive waves of plan withdrawals since 1999. We collected data from 1,055 beneficiaries who were involuntarily disenrolled from a health maintenance organization (HMO) that withdrew from six large markets in 1999 to investigate how they were impacted by the forced change in coverage. Administrative data from this HMO were used to oversample beneficiaries who were perceived to be vulnerable based on their poor health status in the period before the HMO withdrawal. Although most beneficiaries dealt with the withdrawals without major problems, appreciable numbers of beneficiaries did report adverse impacts. These negative impacts were more likely to occur for low-education, low-income, minority beneficiaries. We found little evidence, however, that beneficiaries who were vulnerable due to their poorer health experienced more adverse effects.
Pooled data from the 2007, 2009, and 2011/12 California Health Interview Surveys were used to compare the number of self-reported annual physician visits among 36,808 Medicare beneficiaries ≥65 in insurance groups with differential cost-sharing. Adjusted for adverse selection and a set of health covariates, Medicare fee-for-service (FFS) only beneficiaries had similar physician utilization compared to HMO enrollees but fewer visits compared to those with supplemental (1.04, p=0.001) and Medicaid (1.55, p=0.003) coverage. FFS only beneficiaries in very good or excellent health had fewer visits compared to those of similar health status with supplemental (1.30, p=0.001) or Medicaid coverage (2.15, p=0.002). For sub-populations with several chronic conditions, FFS only beneficiaries also had fewer visits compared to beneficiaries with supplemental or Medicaid coverage. Observed differences in utilization may reflect efficient and necessary physician utilization among those with chronic health needs.
Objective. Although an increasing fraction of Medicare beneficiaries die outside the hospital, the proportion of total Medicare expenditures attributable to care in the last year of life has not dropped. We sought to determine whether disproportionate increases in hospital treatment intensity over time among decedents are responsible for the persistent growth in end-of-life expenditures.
Data Source. The 1985–1999 Medicare Medical Provider Analysis and Review (MedPAR) and Denominator files.
Study Design. We sampled inpatient claims for 20 percent of all elderly fee-for-service Medicare decedents and 5 percent of all survivors between 1985 and 1999 and calculated age-, race-, and gender-adjusted per-capita inpatient expenditures and rates of intensive care unit (ICU) and intensive procedure use. We used the decedent-to-survivor expenditure ratio to determine whether growth rates among decedents outpaced growth relative to survivors, using the growth rate among survivors to control for secular trends in treatment intensity.
Data Collection. The data were collected by the Centers for Medicare and Medicaid Services.
Principal Findings. Real inpatient expenditures for the Medicare fee-for-service population increased by 60 percent...
Thesis (Ph.D.)--University of Rochester. School of Medicine and Dentistry. Dept. of Community and Preventive Medicine, 2008.; Dual eligible beneficiaries are persons who are eligible for both Medicare and
Medicaid. They are among the poorest, sickest populations in the U.S., and cost
Medicare about 60% more per person than do non-dual enrollees. The Balanced
Budget Act (BBA) of 1997 changed the reimbursement model for Medicare Home
Health Care (HHC) from a cost-based method to a bundled Prospective Payment
System (PPS). Before the PPS was implemented in 2000, Medicare HHC agencies
were reimbursed during 1997-2000 by an Interim Payment System (IPS). Studies
evaluating the effect of the BBA on HHC have mostly focused on the impact among
Medicare beneficiaries in general. Little is known about the effect of the BBA on dual
eligibles, as well as its effect on HHC paid for by Medicaid.
This dissertation used Medical Expenditure Panel Survey (MEPS) data from
the pre-BBA (01/1996-09/1997), IPS (10/1997-09/2000), and PPS (10/2000-12/2003)
periods. The study developed a transition probability model to evaluate changes in
utilization and employed the Centers for Medicare and Medicaid Services
Hierarchical Condition Categories (CMS-HCC) model to access changes in patient
HHC case- mix resulting from the BBA.
I confirmed my hypotheses that the BBA had different impacts on case-mix
for Medicare HHC and Medicaid HHC among dual eligible beneficiaries during IPS
One important concern of governments in
developing countries is how to phase out large safety net
programs. The authors evaluate the short-run effects of one
possible exit strategy-programs that promote
self-employment-in Argentina. They provide evidence that a
small fraction of beneficiaries were attracted by this
program. Overall, potential participants to self-employment
are more likely to be female household heads and more
educated beneficiaries relative to the average Jefes
beneficiaries. Using nonexperimental methods, the authors
show that participation in the program does affect the labor
supply of participants, by reducing the probability of
having an outside job, especially for males, and increasing
the total number of hours worked. But the intervention fails
to produce on average income gains to participating
individuals and households in the short run. The fact that a
small subset of former welfare beneficiaries are attracted
to the program, coupled with the fact that only a subset of
participants (younger and more educated beneficiaries...
The Learning on Gender and Conflict in
Africa (LOGiCA) program aims to increase gender-specific
programming in post-conflict countries in Sub-Saharan
Africa, with a focus on demobilization and reintegration
(D&R) in the Great Lakes region (GLR), and
gender-specific issues arising from armed conflict. Specific
objectives are: (i) to increase gender-sensitive programming
in D&R operations in the GLR by better addressing the
gender-differentiated needs of male and female combatants;
and (ii) to generate knowledge and good practices on how to
address gender and conflict issues, with a focus on learning
initiatives addressing sexual and gender-based violence
(SGBV), vulnerable women, and young men at risk in
Sub-Saharan Africa. This study pertains to generating
knowledge on gender sensitivity in D&R programming. The
study aimed to determine: (i) the extent to which the
results of the intervention had been sustained by individual
beneficiaries and associations, (ii) the related role of
support provided through the pilot project...
Dissertação apresentada à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Mestre em Serviço Social; Atualmente, a ambiguidade das diferenças socioeconómicas cria instabilidade na sociedade. Esta conjuntura social despoletou uma perspetiva holística do Estado perante o cidadão mais vulnerável e, com ela, diferentes formas de teorização acerca do social em vários países e, particularmente, em Portugal.
O presente estudo pretende analisar a satisfação dos beneficiários de RSI da Região Autónoma da Madeira. Numa primeira análise, recorreu-se a um quadro teórico, explanando uma perspetiva histórica sobre o RSI em Portugal. Procurou-se, através de uma pesquisa bibliográfica e digital, compreender a situação sociodemográfica dos beneficiários de RSI da RAM. Numa segunda análise, o estudo empírico baseou-se numa metodologia quantitativa com a aplicação de inquéritos a pessoas em situação de carência social, beneficiárias do RSI. Os resultados obtidos corroboram, na sua maioria, com as diferentes perspetivas teóricas mais sedimentadas sobre a dimensão que constitui o RSI.
Nas considerações finais, verifica-se que a maioria dos beneficiários de RSI são do sexo feminino...
This study describes patterns of choosing a provider and of consumer satisfaction among prepaid Medicaid beneficiaries in Monroe County, New York, and compares their level of satisfaction to that of fee-for-service Medicaid beneficiaries. Two interview surveys were conducted with AFDC and HR (general assistance) Medicaid eligibles, the first under the fee-for-service system servicing the Medicaid population, and the second 18 months after the introduction of a mandatory, prepaid managed care system for Medicaid beneficiaries. The results show significant ethnic differences in patient choice of provider and provider site. Given the choice, Medicaid beneficiaries switch from clinics as their usual source of care to private physician practice. Under prepayment, white Medicaid beneficiaries tripled their affiliations with private doctors, while "others" doubled theirs. The results also demonstrate higher levels of patient satisfaction with "humaneness of doctors" and with "quality of care" among those beneficiaries under prepaid care, than previously documented for those under fee-for-service. The evaluations of humaneness and quality of medical system may reflect the respondents' perceptions that the process of receiving care under prepaid...
The Medicare Part D program allows beneficiaries to choose among Part D plans administered by different health plans in order to encourage market competition and give beneficiaries more flexibility. Currently around 40–50 Part D plans are available per region. When faced with so many options, do beneficiaries generally choose the least expensive plan? Using 2009 Part D data, we found that only 5.2% of beneficiaries chose the cheapest plan. Nationwide, beneficiaries on average spent $368 more annually than they would have spent under the cheapest plan available in their region, given their medication needs. Beneficiaries often overprotected themselves by paying higher premiums for plan features they did not need, such as generic drug coverage in the coverage gap. Our findings suggest that beneficiaries need more targeted assistance from the government to choose plans, for example, a customized letter indicating three top plans based on beneficiaries’ medication needs.
This highlight describes the characteristics and inpatient utilization of under age 65 disabled California Medicare beneficiaries by dual eligible status (i.e., Medicaid State buy-in coverage or not). More disabled dually eligible beneficiaries are younger, non-White, and in fee-for-service (FFS) than non-dually eligible beneficiaries. Disabled dually eligible beneficiaries experienced consistently higher hospitalization rates and average length of stay (LOS) than non-dually eligible beneficiaries from 1996 to 2001. Inpatient days remain higher among dually eligible beneficiaries when stratified by the system of care, age, sex, or race. In addition, the hospitalization rate of disabled dually eligible beneficiaries was higher for most diagnoses, but how much higher varied by condition.
This note focuses on the payment into a trust arrangement in favour of a minor beneficiary as contemplated in terms of section 37C (2) of the Pension Funds Act 24 of 1956. The aim is to examine the criteria under which the boards of management of pension funds may deprive a guardian the right to administer benefits on behalf of minor beneficiaries. This examination is conducted within the context of the approach adopted by the Pension Funds Adjudicator in four specific determinations decided prior, but relevant, to the amendments to the Pension Funds Act, where the board in each case unlawfully deprived a guardian of the right to administer death benefits in favour of a minor beneficiary. Therefore, the note will discuss four specific determinations and thereafter comment about the criteria to be used by practitioners. The note argues that these determinations should be welcomed because of their progressive interpretation of the Pension Funds Act and for setting an important precedent for pension fund practitioners and boards. In each case, the Pension Funds Adjudicator found a violation of section 37C. The note also criticises the remedy granted in two of the determinations, namely Moralo v Holcim South African Provident Fund, and Mafe v Barloworld (SA) Retirement Fund Respondent...