A literature review is not an annotated bibliography in which you summarize briefly each article that you have reviewed. While a summary of what you have read is contained within the literature review, it goes well beyond merely summarizing studies. Pay attention to capitalization on the References page. Only capitalize the first letters of Content of this article How to write a literature review Things to avoid Types Structure Final checklist Example 1. How To Write A Literature Review Writing a literature review is perhaps the best piece of literature that a student can work with. This is because writing a literature review only means that you are already near the end of your final requirement in Apr 19, · A literature review is not an annotated bibliography in which you summarize briefly each article that you have reviewed. While a summary of the what you have read is contained within the literature review, it goes well beyond merely summarizing professional literature. pay attention to general document guidelines (e.g. font, margins
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With millions expected to be hospitalized during the COVID pandemic, the U. health care system will be tested as it never has been before, pay literature review. However, some have raised concerns that even these increased Medicare rates may not be sufficient. Once the U. overcomes the immediate public health emergency, attention will likely return to underlying questions regarding provider payments, as well as their impact on health expenditures and out-of-pocket costs.
To inform both discussions, this issue brief reviews the findings of 19 recent studies comparing Medicare and private health insurance payment rates for hospital care and physician services. Across all studies, payments from private insurers are much higher than Medicare payments for both hospital and physician services, although the magnitude of the difference varies ES Figure 1.
Differences across studies may be due to a number of factors, including the representativeness of hospitals, physicians, and insurers used in the analysis, the data collection period, and the characteristics of the markets examined by each study, with some studies focusing on highly consolidated health care markets where providers have stronger negotiating leverage over insurers.
For study descriptions, see the Appendix Table. Figure 1: Private Payment Rates Are Pay literature review Than Medicare Rates for Hospital and Physician Services. Policymakers and analysts continue to debate whether relatively high payments from private payers are necessary to compensate for lower Medicare payments, and the extent to which providers could operate more efficiently to reduce costs.
If provider payments were phased down closer to Medicare levels, providers would have stronger incentives to become more efficient, which could help make health coverage and care more affordable for patients and employers.
However, even some relatively efficient providers appear to have been be losing money on Medicare patients over the past few years, prompting some leading public option and Medicare for all proposals to set hospital payments somewhat above current Medicare rates. While providers may be able to operate more efficiently than they do today, a transition period may be needed to give providers and payers time to adapt to lower payments, and to assess the potential implications for the quality and accessibility of care.
Health care spending in the United States is high and growing faster than the economy. Inhealth expenditures accounted for Moreover, the global COVID pandemic has heightened the urgency surrounding Medicare provider payments.
The Trump administration has signaled that it will use some of this funding to reimburse hospitals for treating uninsured COVID patients at Medicare payment pay literature review. health insurance system. Private insurers currently play a dominant role in the U. In comparison, Medicare accounted for about one quarter of these expenditures in the same year.
Over the years, pay literature review, Medicare has adopted a number of payment systems to manage Medicare spending and encourage providers to operate more efficiently, which in turn has helped slow the growth in premiums and other costs for beneficiaries.
For example, Medicare adopted its prospective payment system inwhich sets payment rates for hospitals in advance based on categories of hospital services known as diagnosis-related groups DRGs. Accordingly, Medicare has been able to limit growth in expenditures per enrollee more effectively than private insurers at several points in recent decades.
Proponents of proposals to broaden the use of Medicare rates, or to use a multiplier of Medicare rates as a benchmark, say that such an approach would help make expanding coverage more affordable and pay literature review excess costs in the U, pay literature review. health care system. However, some have raised concerns that Medicare payments are not keeping pace with provider costs. For example, following the enactment of productivity adjustments to hospital payments in the ACA ofand further reductions under the Budget Control Act ofthe Department of Health and Human Services HHS actuaries warned that the reductions in payments could eventually make it difficult for hospitals to operate profitably — a concern amplified by the hospital industry.
The SGR was ultimately repealed, but left in its wake some concern that future payments would not keep pace with practice costs. We summarize the results of studies examining payments for hospital and physician services, and explore methodological factors that may explain variation in estimates across studies.
This brief reviews findings from studies that compare Medicare and private insurance rates for hospital and physician services. We include studies with data from onward to reflect changes to Medicare provider payment rates established by the Affordable Care Act, pay literature review, and subsequent policy adjustments over the past decade. We identified 19 relevant studies through keyword searches of academic search engines, as well as the pay literature review of governmental, research, and policy organizations that publish work related to health care and health economics.
These studies analyze data reported by the Centers for Medicare and Medicaid Services, private insurers, hospitals, and physician practices. Of these 19 studies, 14 addressed payments to hospitals, eight of which addressed payments for inpatient hospital services, five addressed payments for outpatient services, and seven reported relative payment rates for both types of hospital services combined, with some overlap across studies.
Eight studies addressed payment rates for physician services. The full search methodology is described in the Methods section. To compare findings across multiple studies, we focus on private insurance payments as a percentage of corresponding Pay literature review payment rates reported by each study.
We calculate the average across all studies, by provider category, such as inpatient hospital care. Due to the relatively small number of studies available, pay literature review, our calculation of an overall average gives each study equal weight, recognizing that each varies substantially in methods, data sources, the number and representativeness of providers and payers examined, and geographic focus e.
For studies that report private-to-Medicare payment rate ratios for multiple years, we calculate an average across years to create one estimate used for the cross-study average. This approach prevents disproportionate weighting of results pay literature review studies that reported rates for multiple years.
Moreover, we do not weight studies differently based on factors such as their geographic scope; studies that examined nationwide provider markets are pay literature review equal weight to those that focused on rates for provider in selected states or smaller markets, which may skew overall averages toward the prevailing private-to-Medicare payment ratios in these particular markets, pay literature review.
See the Appendix Table for methodological details for each study. Of the eleven studies that examined differences between Medicare and private insurance rates for hospitals, seven did not distinguish between inpatient and outpatient hospital services.
However, the variation within studies was often substantially wider, as the ratio pay literature review private-to-Medicare rates often differed pay literature review across markets, services, and even individual hospitals. These findings suggest that, even within a given health care market, some individual hospitals may be outliers in that they can command extremely high private reimbursements. Figure 2: Private Payment Rates for All Hospital Services Are About Double Medicare Rates, On Average.
Eight studies compared private insurance and Medicare payment rates for inpatient hospital services. As with the analysis combining inpatient and outpatient services, pay literature review, we averaged estimates for each year in studies that present multiple years of results based on the same methodology and data source.
In keeping with this approach, we also averaged results from the and studies published by Selden and colleagues, pay literature review, as both studies intentionally used the same data source and methodology. There is notably less variation in the ratio of private-to-Medicare payments among studies of inpatient hospital payments than studies that pay literature review rates for all hospital services combined, as may be expected since the range of services represented is narrower, pay literature review.
Five of the reviewed studies examined the difference between private insurance rates and Medicare rates for outpatient hospital services. Across these studies, the ratio of private-to-Medicare payment rates fluctuated more than they did for combined hospital services or pay literature review inpatient hospital services, pay literature review.
Several factors may contribute to variations in estimates across studies, including: the representativeness of hospitals and private insurers; the relative market power of hospitals and insurers in the markets included in the analysis; the types of hospital services examined; the components of private insurance and Medicare payments used to calculate their respective payment rates; and the treatment of out-of-network payments, pay literature review.
These factors are described in greater detail below and in the Appendix Table. Eight studies compared private insurance and Medicare payment rates for physician services. Estimates from each year of the Pay literature review analysis were averaged to calculate the overall average across the studies. Across all studies, private insurance rates for physician services are substantially closer to Medicare levels than private insurance rates for hospital services, which suggests that physician groups generally have less negotiating leverage relative to pay literature review insurers than hospital groups.
Nonetheless, the reviewed studies still demonstrate pronounced variation overall. Much of the variation in reported physician payment rates may be explained by methodological differences, several of which echo those seen among the reviewed studies of hospital payments. Their findings show that, across all hospitals over the period from tocosts for the treatment of Medicare beneficiaries have exceeded Medicare payments, resulting in negative and declining aggregate Medicare margins Figure 6.
Figure 6: Medicare Margins are Negative Overall, but Have Been Positive for Relatively Efficient Hospitals Until Recently. However, MedPAC and other researchers have argued that hospitals could do more to contain their costs. However, even this margin has also been slightly negative since Physician groups have also pointed out discrepancies between their practice costs and Medicare payments.
These include the Physician Practice Information Survey PPIS conducted by the American Medical Association in and PPIS data are still used in the calculation of the Medicare Economic Index MEIwhich measures inflation in the prices of goods and services needed to operate a physician practice.
CMS uses the MEI as a major factor in the determination of annual payment rate updates to the Medicare Physician Fee Schedule. Some providers have argued that Medicare payment rates are too low to cover the reasonable cost of care, and that these shortfalls lead them to raise prices for private payers. However, pay literature review, much of the literature suggests that providers negotiate prices with private insurers irrespective of Medicare rates, and that providers with substantial market power are best positioned to command high prices, allowing them to evade financial pressure to become more efficient.
Moreover, the costs of operating a hospital or physician practice are not fixed, and fluctuate depending pay literature review factors such as available revenues. Currently, many hospitals are facing new costs associated with the infrastructure and resources needed to treat COVID patients, which may require transitional funding increases such as those implemented by the CARES Act. However, once the pandemic has passed, an increased role for Medicare reimbursements could lead many hospitals and other health care providers to phase down their operating costs accordingly.
Thus, predictions of widespread provider closures under Medicare-based reform proposals may be overstated, particularly for proposals that set rates higher than current Medicare rates.
Proposals that would extend Medicare rates, or a multiplier of Medicare rates, to a broader population —such as Medicare-for-All and public option proposals — could also contribute to lower premiums, deductibles, and point-of-care costs for patients. Lower provider payments could lead to lower per capita spending, leading in turn to lower out-of-pocket costs. Employers could also realize savings under proposals that extend Medicare rates to private insurers, which could allow them to redirect some funds currently spent on employee health coverage, including toward wages.
Particularly during the current pandemic, it is worth noting that many privately insured patients hospitalized with COVID would have faced lower out-of-pocket costs if their treatment had been reimbursed at Medicare rates. However, the fact that even some relatively efficient providers are now losing money on Medicare suggests that the capacity of providers to become more efficient will vary substantially.
To address these concerns, some states are moving forward with proposals to establish rates that are higher than Medicare rates but lower than rates currently paid by private insurers, and the current Medicare program has increased payments for inpatient COVID care to better meet the needs of the pandemic response. Even pay literature review overcoming the current crisis, federal and state policymakers will continue facing difficult choices as they seek to rein in health spending while safeguarding pay literature review accessibility and quality of care.
To collect relevant studies that met these criteria, the authors conducted keyword searches of PubMed, Google Scholar, EconPapers, and other academic search engines, as well as the websites of governmental, research, and policy organizations that publish work related to health care and health economics. Additional studies found in the reference lists that resulted pay literature review the initial search were also included. These included a larger body of supporting research, which is cited throughout this brief to provide additional historical pay literature review scientific context to the results presented.
Nineteen studies comparing private and Medicare provider payment rates were identified. Of these, 14 pay literature review addressed payments to hospitals, with eight addressing payments for inpatient services, five addressing payments for outpatient services, and seven reporting relative payment rates for both types of hospital services combined, with some overlap among studies.
Eight of the studies identified addressed payment rates for physician services. Studies reported their results in various formats; for the purposes of this brief, all reported results are expressed in the form of private insurance rates as a percentage of Medicare rates. For each category of study inpatient and outpatient hospital services combined, inpatient hospital services, outpatient hospital services, and physician servicespay literature review, the overall average private insurance payment rate as a percentage of the Medicare rate was calculated across all studies, pay literature review.
In these calculations, each study is given equal weight, and no outliers are removed. For studies that report private-to-Medicare payment rate ratios for multiple years, we calculate an average across years that is used in the calculation of the cross-study average, preventing disproportionate weighting pay literature review studies that reported rates for multiple years, pay literature review.
Studies were not weighted differently based on factors such as geographic scope or the number of providers, pay literature review, insurers, claims, etc. included pay literature review the analysis. This work was supported in part by Arnold Ventures.
We value our funders. KFF maintains full editorial control over all of its policy analysis, polling, and journalism activities. Eric John Lopez is a KFF-UCSF Health Policy Fellow.
Tricia Neuman and Larry Levitt are with the Kaiser Family Foundation.
Literature Reviews: Developing an outline
, time: 7:22How To Write A Literature Review, with Example
Aug 05, · A literature review summarizes and synthesizes the existing scholarly research on a particular topic. Literature reviews are a form of academic writing commonly used in the sciences, social sciences, and humanities. However, unlike research papers, which establish new arguments and make original contributions, literature reviews organize and present existing research A literature review is not an annotated bibliography in which you summarize briefly each article that you have reviewed. While a summary of what you have read is contained within the literature review, it goes well beyond merely summarizing studies. Pay attention to capitalization on the References page. Only capitalize the first letters of Content of this article How to write a literature review Things to avoid Types Structure Final checklist Example 1. How To Write A Literature Review Writing a literature review is perhaps the best piece of literature that a student can work with. This is because writing a literature review only means that you are already near the end of your final requirement in
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