Paying by the rules: How eliminating the cost shift could improve the chances for successful health care reform

Journal of Health Politics, Policy and Law

Volumn 35, Issue 2, 2010, Pages 177-202

  Kilbreth, Elizabeth ^a  

^a UNIVERSITY OF SOUTHERN MAINE   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; ECONOMICS; HEALTH CARE DELIVERY; HEALTH CARE POLICY; HUMAN; INSURANCE; LEGAL ASPECT; REIMBURSEMENT; UNITED STATES;

HEALTH CARE REFORM; HEALTH SERVICES ACCESSIBILITY; HUMANS; INSURANCE, HEALTH, REIMBURSEMENT; MAINE; UNIVERSAL COVERAGE;

EID: 77951150566     PISSN: 03616878     EISSN: 15271927     Source Type: Journal    
DOI: 10.1215/03616878-2009-049     Document Type: Article

References (41)

1. Agency for Healthcare Research and Quality. 2003. Medical Expenditure Panel Survey, Insurance Component Summary. Table II.C.1: Average Total Single Premium (in Dollars) per Enrolled Employee at Private-Sector Establishments That Offer Health Insurance by Firm Size and State: United States, 2003. www.meps.ahrq.gov/mepsweb/data-stats/summ-tables/insr/state/series-2/2003/tiic1. pdf (accessed November 23, 2009).
2. Baker, Newman, and Noyes, LLC. 2001. Maine's Medicare Payment Shortfall: A Special Report Prepared for the Maine Hospital Association. www.themha.org/pubs/Maine-s%20Medicare%20Payment%20Shortfall.pdf.
3. Bergthold, L. 1988. Purchasing Power: Business and Health Policy Change in Massachusetts. Journal of Health Politics, Policy and Law 13: 425-451.
4. Blue Ribbon Commission on Dirigo Health (BRC). 2007. Final Report. Augusta, ME: Governor's Office of Health Policy and Finance.
5. Brown, L. D. 1994. Dogmatic Slumbers: American Business and Health Policy. In The Politics of Health Care Reform, ed. J. A. Morone and G. Belkin, 205-223. Durham, NC: Duke University Press.
6. Centers for Medicare and Medicaid Services (CMS) Office of the Actuary, National Health Statistics Group. 2007. Personal Health Care Expenditures by State of Residence: Summary Tables 1991 - 2004. September. www.cms.hhs.gov/ NationalHealthExpendData/downloads/res-us.pdf (accessed November 23, 2009).
7. Chen, A. S., and M. Weir. 2009. The Long Shadow of the Past: Risk Pooling and the Political Development of Health Care Reform in the States. Journal of Health Politics, Policy and Law 34: 679-716.
8. Christianson, J. B., and S. Trude. 2003. Managing Costs, Managing Benefits: Employer Decisions in Local Health Care Markets. HSR: Health Services Research 38: 357-373.
9. Crozier, D. A. 1982. State Rate Setting: A Status Report. Health Affairs 1 (3): 66-83.
10. Devers, K. J., L. R. Brewster, and L. P. Casalino. 2003. Changes in Hospital Competitive Strategy: A New Medical Arms Race? HSR: Health Services Research 38: 447-469.
11. Devers, K. J., L. P. Casalino, L. S. Rudell, J. J. Stoddard, L. R. Brewster, and T. K. Lake. 2003. Hospitals' Negotiating Leverage with Health Plans: How and Why Has It Changed? HSR: Health Services Research 38: 419-445.
12. Gabel, J. 1997. Ten Ways HMOs Have Changed during the 1990s. Health Affairs 16(3): 134.
13. Goldberger, S. 1990. The Politics of Universal Access: The Massachusetts Health Security Act of 1988. Journal of Health Politics, Policy and Law 15: 857-885.
14. Governor's Office of Health Policy and Finance and the Health Policy Institute, University of Southern Maine. 2006. Maine Continuation State Planning Grant, final report. 2P09OA00042-02-100 Submitted to the Health Resources and Services Administration State Planning Grant Program, U.S. Department of Health and Human Services.
15. House Committees on Ways and Means, Energy and Commerce, and Education and Labor. 2009. Health Reform at a Glance: Public Health Insurance Option. July 14. waysandmeans.house.gov/media/pdf/111/publicoption.pdf.
16. Kane, N. 2009. Keep Hospitals Whole. New York Times, July 12. www.nytimes.com/2009/07/12/opinion/12kane.html.
17. Kilbreth, E. 1995. The Impact of Program Eligibility Criteria on Recipient Access and Continuity of Care: The Experience of the MaineCare Program and the Washington Basic Health Plan. PhD diss., Brandeis University.
18. Kilbreth, E., E. Ziller, and S. Payne. 2005. Trends in Health Service Costs and Utilization, 1995-2001: An Analysis of a Privately Insured Population in Maine. Portland: Muskie School of Public Service, University of Southern Maine.
19. Lesser, C. S., P. B. Ginsburg, and K. J. Devers. 2003. The End of an Era: What Became of the "Managed Care Revolution" in 2001? HSR: Health Services Research 38: 337-355.
20. Martin, A., L. Whittle, K. Levit, G. Won, and L. Himman. 2002. Health Care Spending during 1991-1998: A Fifty-State Review. Health Affairs 21 (4): 114.
21. Martin, C. J. 1993. Together Again: Business, Government, and the Quest for Cost Control. Journal of Health Politics, Policy and Law 18: 359-393.
22. -. 2003. Employers: Passive Purchasers or Provocateurs? Journal of Health Politics, Policy and Law 28: 317-340.
23. Martin, G., and D. Rooks. 2009. National Health Reform: Lessons from Maine. Augusta: Maine Center for Economic Policy.
24. McDonough, J. E. 1992. Mass Retreat: The Demise of Massachusetts Rate Regulation. Journal of American Health Policy 2 (5): 40-44.
25. -. 1997. Tracking the Demise of State Hospital Rate Setting. Health Affairs 16(1): 142-149.
26. Milbank Memorial Fund, National Association of State Budget Officers, and the Reforming States Group. 2003. State Health Care Expenditure Report. April. New York: Milbank Memorial Fund. www.milbank.org/reports/2000shcer/index.html.
27. Murray, R. 2006. Health Care Regulation: Presentation for the Brazilian National Supplementary Health Agency. Baltimore: Health Services Cost Review Commission.
28. Nichols, L. M., P. B. Ginsburg, R. A. Berenson, J. Christianson, and R. E. Hurley. 2004. Are Market Forces Strong Enough to Deliver Efficient Health Care Systems? Confidence Is Waning. Health Affairs 23 (2): 8-21.
29. Porter, M. E., and E. O. Teisberg. 2006. Redefining Health Care: Creating Value-Based Competition on Results. Boston, MA: Harvard Business School Press.
30. Schneider, A., R. Elias, R. Garfield, R. Rousseau, and V. Wachino. 2002. The Medicaid Resource Book. Washington, DC: Kaiser Commission on Medicaid and the Uninsured.
31. Schramm, C. J., S. Renn, and B. Biles. 1986. Controlling Hospital Cost Inflation: New Perspectives on State Rate Setting. Health Affairs 5 (3): 22-33.
32. Sloan, F. A. 1983. Rate Regulation as a Strategy for Hospital Cost Control: Evidence from the Last Decade. Milbank Memorial Fund Quarterly/Health and Society 61 (2): 195-221.
33. State of Maine, Bureau of Insurance. 2005. Market Snapshot - Small Group Health.www.state.me.us/pfr/insurance/employer/snapshot-small-group.htm (accessed November 23, 2009).
34. Stone, D. 1994. The Struggle for the Soul of Health Insurance. In The Politics of Health Care Reform, ed. J. A. Morone and G. S. Belkin, 26-56. Durham, NC: Duke University Press.
35. -. 2009. Single Payer - Good Metaphor, Bad Politics. Journal of Health Politics, Policy and Law 34: 531-542.
36. Strunk, B. C., P. B. Ginsburg, and J. R. Gabel. 2002. Tracking Health Care Costs: Growth Accelerates Again in 2001. Health Affairs Web Exclusive: W299-W310. September 25. content.healthaffairs.org/cgi/reprint/hlthaff.w2.299v1.
37. Swenson, P., and S. Greer. 2002. Foul Weather Friends: Big Business and Health Care Reform in the 1990s in Historical Perspective. Journal of Health Politics, Policy and Law 27: 605-638.
38. Thorpe, K. E. 1987. Does All-Payer Rate Setting Work? The Case of New York Prospective Hospital Reimbursement Methodology. Journal of Health Politics, Policy and Law 12: 391-408.
39. Tumulty, K. 2009. PhRMA Deal Puts Obama, Congressional Dems at Odds. Time .com, August 7. www.time.com/time/politics/article/0,8599,1915139,00.html.
40. Volpp, K. G., and B. Siegel. 1993. State Model New Jersey: Long Term Experience with All-Payer State Rate Setting. Health Affairs 12 (2): 59-65.
41. Wihry, D., J. Fralich, and E. J. Schneiter. 1993. The Political Economy of Hospital Rate Regulation in Maine. Maine Policy Review 2 (2): 18-34.