Foreword

Atkinson, Brooks

doi:10.2307/j.ctt1g2kn69.4

Cited by 2 publications

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“…Maryland’s global budget program builds on the state’s hospital rate-setting system, which was created in the 1970s and establishes a set of regulated rates at which hospitals bill all payers. This system exempts Maryland hospitals from Medicare’s national inpatient and outpatient Prospective Payment Systems . Like Medicare’s national hospital payment programs, Maryland’s prior system paid hospitals per Diagnosis Related Group (for inpatient care) or per service (outpatient care) without constraining total revenue.…”

Section: Methodsmentioning

confidence: 99%

Changes in Health Care Use Associated With the Introduction of Hospital Global Budgets in Maryland

et al. 2018

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IMPORTANCEIn 2014, the State of Maryland placed the majority of its hospitals under all-payer global budgets for inpatient, hospital outpatient, and emergency department care. Goals of the program included reducing unnecessary hospital utilization and encouraging greater use of primary care.OBJECTIVE To compare changes in hospital and primary care use through the first 2 years of Maryland's hospital global budget program among fee-for-service Medicare beneficiaries in Maryland vs matched control areas. DESIGN, SETTING, AND PARTICIPANTSWe matched 8 Maryland counties (94 967 beneficiaries) with hospitals in the program to 27 non-Maryland control counties (206 389 beneficiaries). Using difference-in-differences analysis, we compared changes in hospital and primary care use in Maryland vs the control counties from before (2009)(2010)(2011)(2012)(2013) to after (2014)(2015) the payment change, using 2 different assumptions. First, we assumed that preintervention differences between Maryland and the control counties would have remained constant past 2014 had Maryland not implemented global budgets (parallel trend assumption). Second, we assumed that differences in preintervention trends would have continued without the payment change (differential trend assumption).MAIN OUTCOMES AND MEASURES Hospital stays (defined as admissions and observation stays); return hospital stays within 30 days of a prior hospital stay; emergency department visits that did not result in admission; price-standardized hospital outpatient department (HOPD) utilization; and visits with primary care physicians (overall and within 7 days of a hospital stay). RESULTSWe matched 8 Maryland counties with hospitals in the program (94 967 beneficiaries; 41.8% male; mean [SD] age, 72.3 [12.2] years) to 27 non-Maryland control counties (206 389 beneficiaries; 42.8% male; mean [SD] age, 71.7 [12.5] years). Assuming parallel trends, we estimated a differential change in Maryland of −0.47 annual hospital stays per 100 beneficiaries (95% CI, −1.65 to 0.72; P = .43) from the preintervention period (2009)(2010)(2011)(2012)(2013) to 2015, but assuming differential trends, we estimated a differential change in Maryland of −1.24 stays per 100 beneficiaries (95% CI, −2.46 to −0.02; P = .047). Assuming parallel trends, we found a significant increase in primary care visits (+10.6 annual visits/100 beneficiaries; 95% CI, 4.6 to 16.6 annual visits/100 beneficiaries; P = .001), but assuming differential trends, we found no change (−0.8 visits/100 beneficiaries; 95% CI, −10.6 to 9.0 visits/100 beneficiaries; P = .87). Comparing estimates with both trend assumptions, we found no consistent changes in emergency department visits, return hospital stays, HOPD use, or posthospitalization primary care visits associated with Maryland's program. CONCLUSIONS AND RELEVANCEWe did not find consistent evidence that Maryland's hospital global budget program was associated with reductions in hospital use or increases in primary care visits among fee-for-service Medicare beneficiaries ...

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Section: Methodsmentioning

confidence: 99%

Changes in Health Care Use Associated With the Introduction of Hospital Global Budgets in Maryland

et al. 2018

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“…A theme in each of their stories is a jolt to self-image: “This is not who I am, not who I want to be” ( 39 ). One recovered alcoholic describes the process: “You tear yourself apart, examine each individual piece, toss out the useless, rehabilitate the useful, and put your moral self back together again” ( 40 ). These are not the sentiments of people in helpless thrall to their diseased brains.…”

Section: The Addiction Paradoxmentioning

confidence: 99%

Addiction and the Brain-Disease Fallacy

Satel

Lilienfeld

2014

Front. Psychiatry

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From Brainwashed: The Seductive Appeal of Mindless Neuroscience by Sally Satel and Scott Lilienfeld, copyright © 2013. Reprinted by permission of Basic Books, a member of The Perseus Books Group.The notion that addiction is a “brain disease” has become widespread and rarely challenged. The brain-disease model implies erroneously that the brain is necessarily the most important and useful level of analysis for understanding and treating addiction. This paper will explain the limits of over-medicalizing – while acknowledging a legitimate place for medication in the therapeutic repertoire – and why a broader perspective on the problems of the addicted person is essential to understanding addiction and to providing optimal care. In short, the brain-disease model obscures the dimension of choice in addiction, the capacity to respond to incentives, and also the essential fact people use drugs for reasons (as consistent with a self-medication hypothesis). The latter becomes obvious when patients become abstinent yet still struggle to assume rewarding lives in the realm of work and relationships. Thankfully, addicts can choose to recover and are not helpless victims of their own “hijacked brains.”

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Foreword

Cited by 2 publications

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Changes in Health Care Use Associated With the Introduction of Hospital Global Budgets in Maryland

Changes in Health Care Use Associated With the Introduction of Hospital Global Budgets in Maryland

Addiction and the Brain-Disease Fallacy

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