View Research by Author - W. Pete Welch

Citation URL: http://www.urban.org/WPeteWelch

To learn more about the determinants of end-of-life costs, this study compares decedents' and survivors' use of physician services in the United States and two major Canadian provinces, Quebec and British Columbia. It is based on physician claims data for 1992 from the U.S. Health Care Financing Administration, the Quebec Ministry of Health, the British Columbia Ministry of Health, and a 1 percent random sample of Medicare beneficiaries. Physician service utilization for persons in their last six months of life, aggregated into relative value units, is compared by type of service with that of survivors. The authors also briefly discuss the differences in resources, values, and practice style between the two countries.

The goal of this report was to assess the relative volume and price of physician services in Canada and the United States through a comparative analysis of 1992 claims data from Canadian provincial ministries of health and from the U.S. Health Care Financing Administration. The study groups consisted of all the elderly in the three largest Canadian provinces and a 1 percent random sample of U.S. elderly Medicare beneficiaries. Patterns of use of physician services and procedures are described, and several possible explanations for differences between the patterns in the United States and Canada are suggested.

In the absence of federal health care reform legislation, states are designing their own reforms to the way health care is financed and delivered. This databook presents detailed data on the utilization of physician services by state and by metropolitan statistical area for Medicare. Beyond offering background information, these data can provide states with the means of investigating which services are under- or over-supplied in certain areas of the state.

Only recently have studies on Medicare use rates incorporated estimates of person-level randomness. Physician profiling studies, in which physicians are given information on the services that they delivered, should incorporate standard errors of the mean. This report estimates the mean volume and intensity of physician services per Medicare beneficiary and the standard errors associated with such measurements. Several estimators are discussed because 12 percent of Medicare beneficiaries are eligible for only part of a year.

Several health care reform proposals may result in Medicaid beneficiaries and the commercially insured being enrolled in a common purchasing pool. Little is known about the cost of Medicaid beneficiaries relative to the cost of the commercially insured within a given delivery system. This report analyzes the cost of Medicaid enrollees relative to the cost of commercial enrollees using data from nine health maintenance organizations. The cost data were derived from either claims data or encounter data.

Several health care reform proposals may result in Medicaid beneficiaries and the commercially insured being enrolled in a common purchasing pool. Little is known about the cost of Medicaid beneficiaries relative to the cost of the commercially insured within a given delivery system. This report analyzes the cost of Medicaid enrollees relative to the cost of commercial enrollees using data from nine health maintenance organizations. The cost data were derived from either claims data or encounter data.

Any realistic attempt at reforming the U.S. health care system must tackle a strong cultural aversion to centralized administration and high public-sector costs, an entrenched private health insurance industry, and an established tradition of employer-based health insurance. The authors analyze the advantages and disadvantages of different reform alternatives and present a proposal for reform that recognizes these cultural and political realities.

Any realistic attempt at reforming the U.S. health care system must tackle a strong cultural aversion to centralized administration and high public-sector costs, an entrenched private health insurance industry, and an established tradition of employer-based health insurance. The authors analyze the advantages and disadvantages of different reform alternatives and present a proposal for reform that recognizes these cultural and political realities.

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