Research by Author & Topic

Publications by Stephen Zuckerman on Hospitals and Physicians

This paper demonstrates that while fees for physician evaluation and management increased over the first ten years of the Medicare Fee Schedule, the quantity of imaging services and non-major procedures increased even more, making the share of program spending on evaluation and management services in 2002 the same as it was in 1992. Two factors explained the differential spending growth across types of services: the introduction of new services and the process for reviewing and revising fees. The authors argue that differences in expenditure growth across service types affect Medicare's costs and should be considered in the program's spending control policies.

This study, funded by the Maine Health Access Foundation, presented alternative estimates of the costs of health care that uninsured Maine residents receive and determined how much public revenue was available to offset those costs. Using data from health care providers, the study estimated that the costs of caring for the uninsured in Maine were $138 million in 2005, with hospitals and Veterans' Affairs facilities identified as the largest providers. Estimates based on household survey data from the Medical Expenditure Panel Survey showed that uncompensated care costs for the uninsured were only $81 million in 2005. The report discusses possible reasons for the large discrepancy between these two sources. Our review of federal and state funding sources in 2005 suggests there were roughly $110 million available to offset these costs of caring for the uninsured.

Hurricane Katrina destroyed much of the New Orleans health care system. The devastation was especially profound for the low-income uninsured, most of whom depend heavily on a handful of providers. Focusing on the low-income population, this essay examines some of the early responses to the many health care issues that surfaced in Katrina's wake, and discusses emerging issues that both private and public decisionmakers will face. One potential strategy for rebuilding is a health care safety net based on a continuum of care to low-income residents, integrating a network of community clinics with a new but smaller Charity Hospital.

This study examines the effects of Medicaid payment generosity on access and care for Medicaid adults and children. We used data from the National Surveys of America's Families for 1997, 1999, and 2002 and the Urban Institute Medicaid capitation rate surveys. Higher payment rates improve some aspects of care for Medicaid beneficiaries, but the effects are not dramatic. Higher payments increase the probability of having a usual source of care and having at least one visit to a doctor or other health professional for Medicaid adults, and produce more positive assessments of the health care received by adults and children. (Shen, Yu-Chu and Zuckerman, Stephen. June 2005. "The Effect of Medicaid Payment Levels on Access and Use Among Beneficiaries." Health Services Research 40(3): 723-744.)

This paper provides policy analysis of the geographic adjusters used in the Medicare physician payment system. In 2003, Medicare set a floor on the adjuster for the work component of each fee so that every area is paid at least at the average, regardless of its relative costs. We review the conceptual foundation for the geographic practice cost adjusters, emphasizing why researchers and policymakers included an adjustment for geographic differences in the costs of physicians' work. Finally, we discuss the floor provision in the context of the broader aims of its proponents—to increase access to physician services in those areas affected by the floor.

Urban Institute researcher, Stephen Zuckerman, testifies before the Ways and Means Committee on the geographic practice costs adjustment in the Medicare Physician Fee Schedule. He explains why it is necessary to adjust for differences in the costs of physicians' time as well as other practice expenses (employee wages, office rents and malpractice insurance premiums). The testimony argues against setting an arbitrary floor on the geographic adjuster for physicians' time as a way of raising Medicare fees in low cost areas.

The past decade of dramatic growth in Medicaid managed care reveals much about how states and federal officials have worked together through the waiver granting process. States have successfully navigated the waiver process to implement managed care programs and several have introduced genuine innovations to enhance the operation and effectiveness of their Medicaid programs. States have generally proven themselves to be responsible, though at times overly ambitious, innovators. States have learned from one another and often draw on other states' earlier experiences in Medicaid managed care programs. Managed care innovation has been an especially challenging enterprise for states as providers enter and leave the health care market. Forays into managed care amplified variations in state Medicaid programs that would not have been possible without the waiver process.

In the face of rising hospital costs, the Medicare program, which dominates the hospital market, introduced two major reforms in the way hospitals were reimbursed. These changed the payment method from essentially full-cost reimbursement to a fixed payment per case. Were these regulatory changes successful in controlling costs? If so, why has the trend reversed, and what does the change imply about hospital profitability? The authors address these and related questions with an econometric analysis based on detailed annual data on almost 1,300 short-term, general, nonfederal hospitals in the continental United States between 1980 and 1988.

In the face of rising hospital costs, the Medicare program, which dominates the hospital market, introduced two major reforms in the way hospitals were reimbursed. These changed the payment method from essentially full-cost reimbursement to a fixed payment per case. Were these regulatory changes successful in controlling costs? If so, why has the trend reversed, and what does the change imply about hospital profitability? The authors address these and related questions with an econometric analysis based on detailed annual data on almost 1,300 short-term, general, nonfederal hospitals in the continental United States between 1980 and 1988.