Thomas G Mcguire
Datos Biográficos
| ID | 1741089 |
|---|---|
| NOMBRE | Thomas G Mcguire |
| NOMBRES | Thomas G |
| APELLIDO | Mcguire |
| FIRMA | MCGUIRE T G |
| AFILIACIONES | Harvard University |
| VERIFICADO | No |
| TOTAL DE OBRAS | 34 |
| TOTAL DE CITAS | 113 |
| TOTAL COMO AUTOR | 34 |
| TOTAL COMO EDITOR | 0 |
| PRIMER AÑO DE PUBLICACIÓN | 1981 |
| AÑO MÁS RECIENTE DE PUBLICACIÓN | 2025 |
| ÍNDICE H | 5 |
Algorithms to Improve Fairness in Medicare Risk Adjustment
Results of this study suggest that constrained regression and postprocessing can incorporate fairness objectives into the Medicare risk adjustment algorithm with minimal reduction in overall fit. These feasible changes to the Medicare risk adjustment algorithm could be considered by policymakers aiming to address health care disparities through payment system reform
Extreme under and overcompensation in morbidity-based health plan payments
Improving risk-equalization in Switzerland
The Swiss healthcare financing system is on the verge of one of its largest reforms. The Swiss parliament is currently debating how to reallocate about 20 % of total health expenditures. Swiss cantons make substantial tax-funded contributions to health expenditures by paying 55 % of hospital inpatient costs. As health insurers are fully responsible for all outpatient costs, the present system may provide unintended incentives to treat patients in…
Medicaid Expansion’s Spillover to the Criminal Justice System
Spillovers from the Affordable Care Act Medicaid expansion to other social-sector outcomes have received little attention. One that may be especially salient for public policy is the impact of expanded eligibility on jail-related outcomes. This study compares recidivism outcomes in three non-expansion counties to nearby expansion counties before and after Medicaid expansion. Using forty-eight months of arrest data from six urban county jails, we …
The Power of Reinsurance in Health Insurance Exchanges to Improve the Fit of the Payment System and Reduce Incentives for Adverse Selection
Risk adjustment and reinsurance protect plans against risk of losses and contend with adverse selection in the new health insurance Exchanges. This article assesses the power of reinsurance in the context of other plan payment features, including prospective and concurrent risk adjustment. Using data from the Medicare Expenditure Panel Survey (MEPS) to draw an "Exchange population," we simulate the contribution of reinsurance to improving the fit…
Longitudinal Racial/Ethnic Disparities in Antimanic Medication Use in Bipolar-I Disorder
OBJECTIVE: To examine racial/ethnic longitudinal disparities in antimanic medication use among adults with bipolar-I disorder. METHODS: Observational study using administrative data from Florida's Medicaid program, July 1997 to June 2005, for enrollees diagnosed with bipolar-I disorder (N = 13,497 persons; 126,413 person-quarters). We examined the likelihood of receiving one of the following during a given quarter: (1) any antimanic agent (antips…
Clinical Inertia in Depression Treatment
OBJECTIVE: To explore reasons for clinical inertia in the management of persistent depression symptoms. RESEARCH DESIGN: We characterized patterns of treatment adjustment in primary care and their relation to the patient's clinical condition by modeling transition to a given treatment "state" conditional on the current state of treatment. We assessed associations of patient, clinician, and practice barriers with adjustment decisions. SUBJECTS: Su…
Mental Health in the Context of Health Disparities
New Evidence Regarding Racial And Ethnic Disparities In Mental Health
Minorities have, in general, equal or better mental health than white Americans, yet they suffer from disparities in mental health care. This paper reviews the evidence for mental health and mental health care disparities, comparing them to patterns in health. Strategies for addressing disparities in health care, such as improving access to and quality of care, should also work to eliminate mental health care disparities. In addition, a diverse m…
Testing for Statistical Discrimination by Race/Ethnicity in Panel Data for Depression Treatment in Primary Care
Enhanced physician-patient communication and use of standardized depression instruments may reduce statistical discrimination arising from clinical uncertainty and be useful in reducing racial/ethnic inequities in depression treatment
Health Insurance Coverage for Vulnerable Populations
This paper examines the role that population vulnerabilities play in insurance coverage for a representative sample of Latinos and Asians in the United States. Using data from the National Latino and Asian American Study (NLAAS), these analyses compare coverage differences among and within ethnic subgroups, across states and regions, among types of occupations, and among those with or without English language proficiency. Extensive differences ex…
Changes in Racial Differences in Use of Medical Procedures and Diagnostic Tests Among Elderly Persons
Objectives. We used 1997 Medicare data to replicate an earlier study that used data from 1986 to examine racial differences in usage of specific medical procedures or tests among elderly persons. Methods. We used 1997 physician claims data to obtain a random sample of 5% of Medicare beneficiaries aged 65 years and older. We used this sample to study 30 procedures and tests that were analyzed in the 1986 study, as well as several new procedures th…
Prejudice, clinical uncertainty and stereotyping as sources of health disparities
Why Don't Private Employers Use Risk Adjustment? Conference Overview
In spite of advice from some researchers, private employers do not use formal risk adjustment to pay health plans. A conference, “Private Employers and Risk Adjustment,” was held in February 2000 to consider the meaning of employers' actions. This overview introduces the papers written for that conference
Private Employers Don't Need Formal Risk Adjustment
This paper lays down a set of hypotheses to explain why private employers do not use formal risk adjustment. The theme running through these hypotheses is simple: private employers don't need formal adjustment because they have better tools for dealing with adverse selection than formal risk adjustment provides. Open enrollment provisions, premium negotiations, and restricting employees' choices of health plans are mechanisms superior to formal r…
Using State Information Systems for Drug Abuse Services Research
Political and social demands for effective and cost-effective treatments for drug and alcohol dependence challenge public policy makers and services researchers to assess provider performance, monitor client outcomes, and document effectiveness and cost-effectiveness of care. The information systems built and maintained by the public authorities that fund substance abuse treatment services are an underused source of information on provider perfor…
Supply-Side and Demand-Side Cost Sharing in Health Care
In health markets, the price paid by insured consumers when health care services are demanded can be set separately from the price paid to providers when services are supplied. This fact suggests two alternate strategies for controlling the costs of health care: demand-side cost sharing, where patients must pay more in co-payments or deductibles, and supply-side cost sharing, which seeks to alter the incentives of health care workers to provide c…
Outpatient benefits for mental health services in Medicare
Revision of Medicare's benefit for outpatient mental health care is long overdue. The Omnibus Reconciliation Act of 1987 expands the covered limit to $2,200 (from the $500 set in 1966) but retains the 50% coinsurance requirement for beneficiaries. There are several strong arguments supporting further changes in the benefit to reduce the coinsurance and include psychologists as covered providers. These are need among the elderly, changes in Medica…
Outpatient benefits for mental health services in Medicare
The Economics of Long‐Term Care for the Mentally Ill
Systems of long‐term care for the mentally ill have been largely shaped by financing and reimbursement, rather than sound treatment principles. An undue emphasis on institutional care and the lack of coordination among providers can be attributed to perverse economic incentives and multiple payers. This article argues that, because of the special nature of long‐term psychiatric disabilities, there is a predictable underutilization of long‐term ps…
Inpatient Psychiatric Units in Nonteaching General Hospitals
The purpose of the study was to determine the extent to which the existence of inpatient psychiatric units (IPU) in general hospitals is related to patient service "needs," to certain economic and organizational characteristics of general hospitals, or to both. Area and institutional characteristics of general hospitals in Massachusetts were analyzed with multivariate techniques. Interviews were also conducted with representatives from hospitals …
Patterns of mental health utilization over time in a fee-for-service population
This paper examines the multi-year patterns of ambulatory mental health care in a population of individuals continuously eligible to receive care in a fee-for-service setting. Among the 14,000 individuals eligible for all three years, 14 per cent used outpatient mental health services during at least one of the three years. Almost 70 per cent of the individuals with some use in 1980 used services during 1981 or 1982. The heaviest use of outpatien…
Ownership and Performance
Policy analysts and researchers have been concerned with the growth and impact of for-profit institutions providing health care services. Research results to date have been mixed on the effect of ownership on quality and cost to payers. Equivocal findings may be due, in part, to measurement limitations inherent in facility-level data. This study reports results from a homogeneously insured population receiving outpatient mental health care at pro…
The Effect of Vendorship on the Distribution of Clinical Social Work Services
This study examines the impact of vendorship on the distribution of clinical social work services within the various sectors of the mental health and social service systems and within different types of private practice. Social workers in Massachusetts were surveyed in 1982 and 1983, four and eighteen months following enactment of a state vendorship law. Study findings indicate that social workers have not left organized settings for private prac…
Mental Health Cost Models; Refinements and Applications
This paper describes a 2-year study whose goal was to refine Burton Weisbrod's cost model for public programs for the chronically mentally ill. The authors made comprehensive cost assessments of all the resources, including treatment programs, used by a small sample of severely disturbed chronically ill patients. Refinement of the model included a method to assess capital costs of public facilities. The use of disaggregated patient information pe…
Prejudice, clinical uncertainty and stereotyping as sources of health disparities
Economic aspects of health
Changes in Racial Differences in Use of Medical Procedures and Diagnostic Tests Among Elderly Persons
Objectives. We used 1997 Medicare data to replicate an earlier study that used data from 1986 to examine racial differences in usage of specific medical procedures or tests among elderly persons. Methods. We used 1997 physician claims data to obtain a random sample of 5% of Medicare beneficiaries aged 65 years and older. We used this sample to study 30 procedures and tests that were analyzed in the 1986 study, as well as several new procedures th…
Supply-Side and Demand-Side Cost Sharing in Health Care
In health markets, the price paid by insured consumers when health care services are demanded can be set separately from the price paid to providers when services are supplied. This fact suggests two alternate strategies for controlling the costs of health care: demand-side cost sharing, where patients must pay more in co-payments or deductibles, and supply-side cost sharing, which seeks to alter the incentives of health care workers to provide c…
Budget-maximizing governmental agencies
Testing for Statistical Discrimination by Race/Ethnicity in Panel Data for Depression Treatment in Primary Care
Enhanced physician-patient communication and use of standardized depression instruments may reduce statistical discrimination arising from clinical uncertainty and be useful in reducing racial/ethnic inequities in depression treatment
Using State Information Systems for Drug Abuse Services Research
Political and social demands for effective and cost-effective treatments for drug and alcohol dependence challenge public policy makers and services researchers to assess provider performance, monitor client outcomes, and document effectiveness and cost-effectiveness of care. The information systems built and maintained by the public authorities that fund substance abuse treatment services are an underused source of information on provider perfor…
The Effect of Vendorship on the Distribution of Clinical Social Work Services
This study examines the impact of vendorship on the distribution of clinical social work services within the various sectors of the mental health and social service systems and within different types of private practice. Social workers in Massachusetts were surveyed in 1982 and 1983, four and eighteen months following enactment of a state vendorship law. Study findings indicate that social workers have not left organized settings for private prac…
Patterns of mental health utilization over time in a fee-for-service population
This paper examines the multi-year patterns of ambulatory mental health care in a population of individuals continuously eligible to receive care in a fee-for-service setting. Among the 14,000 individuals eligible for all three years, 14 per cent used outpatient mental health services during at least one of the three years. Almost 70 per cent of the individuals with some use in 1980 used services during 1981 or 1982. The heaviest use of outpatien…
Vendorship and Social Work in Massachusetts
Social workers newly eligible for vendorship in Massachusetts were surveyed about work and billing practices. Thirty percent of the respondents indicated a willingness to open or expand private practice. Costs to insurers, however, will not equal new social worker billings, since many of these claims have previously been submitted under other names
Budget-maximizing governmental agencies
Price and Membership in a Prepaid Group Medical Practice
Federal interest in prepaid group practices as a means to control rising health care costs in reviving. This article is an empirical study of price and membership at a prepaid group practice among employees of Yale University. This article is the first to estimate the effect of price on the decision for membership in a prepaid group. The probability of joining the prepaid group is estimated to be a function of the relative price of the prepaid gr…
Financing Psychotherapy
Reimbursement policy and cost-effective mental health care
Reimbursement policy and cost-effective mental health care
Economic aspects of health
Cost sharing and the demand for ambulatory mental health services
Cost sharing and the demand for ambulatory mental health services
Vendorship and Social Work in Massachusetts
Social workers newly eligible for vendorship in Massachusetts were surveyed about work and billing practices. Thirty percent of the respondents indicated a willingness to open or expand private practice. Costs to insurers, however, will not equal new social worker billings, since many of these claims have previously been submitted under other names
The Effect of Vendorship on the Distribution of Clinical Social Work Services
This study examines the impact of vendorship on the distribution of clinical social work services within the various sectors of the mental health and social service systems and within different types of private practice. Social workers in Massachusetts were surveyed in 1982 and 1983, four and eighteen months following enactment of a state vendorship law. Study findings indicate that social workers have not left organized settings for private prac…
Mental Health Cost Models; Refinements and Applications
This paper describes a 2-year study whose goal was to refine Burton Weisbrod's cost model for public programs for the chronically mentally ill. The authors made comprehensive cost assessments of all the resources, including treatment programs, used by a small sample of severely disturbed chronically ill patients. Refinement of the model included a method to assess capital costs of public facilities. The use of disaggregated patient information pe…
Ownership and Performance
Policy analysts and researchers have been concerned with the growth and impact of for-profit institutions providing health care services. Research results to date have been mixed on the effect of ownership on quality and cost to payers. Equivocal findings may be due, in part, to measurement limitations inherent in facility-level data. This study reports results from a homogeneously insured population receiving outpatient mental health care at pro…
Patterns of mental health utilization over time in a fee-for-service population
This paper examines the multi-year patterns of ambulatory mental health care in a population of individuals continuously eligible to receive care in a fee-for-service setting. Among the 14,000 individuals eligible for all three years, 14 per cent used outpatient mental health services during at least one of the three years. Almost 70 per cent of the individuals with some use in 1980 used services during 1981 or 1982. The heaviest use of outpatien…
Outpatient benefits for mental health services in Medicare
Revision of Medicare's benefit for outpatient mental health care is long overdue. The Omnibus Reconciliation Act of 1987 expands the covered limit to $2,200 (from the $500 set in 1966) but retains the 50% coinsurance requirement for beneficiaries. There are several strong arguments supporting further changes in the benefit to reduce the coinsurance and include psychologists as covered providers. These are need among the elderly, changes in Medica…
Outpatient benefits for mental health services in Medicare
The Economics of Long‐Term Care for the Mentally Ill
Systems of long‐term care for the mentally ill have been largely shaped by financing and reimbursement, rather than sound treatment principles. An undue emphasis on institutional care and the lack of coordination among providers can be attributed to perverse economic incentives and multiple payers. This article argues that, because of the special nature of long‐term psychiatric disabilities, there is a predictable underutilization of long‐term ps…
Inpatient Psychiatric Units in Nonteaching General Hospitals
The purpose of the study was to determine the extent to which the existence of inpatient psychiatric units (IPU) in general hospitals is related to patient service "needs," to certain economic and organizational characteristics of general hospitals, or to both. Area and institutional characteristics of general hospitals in Massachusetts were analyzed with multivariate techniques. Interviews were also conducted with representatives from hospitals …
Supply-Side and Demand-Side Cost Sharing in Health Care
In health markets, the price paid by insured consumers when health care services are demanded can be set separately from the price paid to providers when services are supplied. This fact suggests two alternate strategies for controlling the costs of health care: demand-side cost sharing, where patients must pay more in co-payments or deductibles, and supply-side cost sharing, which seeks to alter the incentives of health care workers to provide c…
Using State Information Systems for Drug Abuse Services Research
Political and social demands for effective and cost-effective treatments for drug and alcohol dependence challenge public policy makers and services researchers to assess provider performance, monitor client outcomes, and document effectiveness and cost-effectiveness of care. The information systems built and maintained by the public authorities that fund substance abuse treatment services are an underused source of information on provider perfor…
Why Don't Private Employers Use Risk Adjustment? Conference Overview
In spite of advice from some researchers, private employers do not use formal risk adjustment to pay health plans. A conference, “Private Employers and Risk Adjustment,” was held in February 2000 to consider the meaning of employers' actions. This overview introduces the papers written for that conference
Private Employers Don't Need Formal Risk Adjustment
This paper lays down a set of hypotheses to explain why private employers do not use formal risk adjustment. The theme running through these hypotheses is simple: private employers don't need formal adjustment because they have better tools for dealing with adverse selection than formal risk adjustment provides. Open enrollment provisions, premium negotiations, and restricting employees' choices of health plans are mechanisms superior to formal r…
Prejudice, clinical uncertainty and stereotyping as sources of health disparities
Changes in Racial Differences in Use of Medical Procedures and Diagnostic Tests Among Elderly Persons
Objectives. We used 1997 Medicare data to replicate an earlier study that used data from 1986 to examine racial differences in usage of specific medical procedures or tests among elderly persons. Methods. We used 1997 physician claims data to obtain a random sample of 5% of Medicare beneficiaries aged 65 years and older. We used this sample to study 30 procedures and tests that were analyzed in the 1986 study, as well as several new procedures th…
Health Insurance Coverage for Vulnerable Populations
This paper examines the role that population vulnerabilities play in insurance coverage for a representative sample of Latinos and Asians in the United States. Using data from the National Latino and Asian American Study (NLAAS), these analyses compare coverage differences among and within ethnic subgroups, across states and regions, among types of occupations, and among those with or without English language proficiency. Extensive differences ex…
Testing for Statistical Discrimination by Race/Ethnicity in Panel Data for Depression Treatment in Primary Care
Enhanced physician-patient communication and use of standardized depression instruments may reduce statistical discrimination arising from clinical uncertainty and be useful in reducing racial/ethnic inequities in depression treatment
Medicine (26 obras) · Healthcare Policy and Management (24 obras) · Business (21 obras) · Psychiatry (18 obras) · Economics (17 obras) · Health care (17 obras) · Mental health (15 obras) · Political science (14 obras) · Psychology (13 obras) · Actuarial science (10 obras)