Payment levels, resource use, and insurance risk of medicaid versus private insured in three states.

Concerns with access and costs in the Medicaid program often lead policy makers to consider alternatives. These include subsidizing poor persons' purchases of health insurance in private markets or integrating Medicaid beneficiaries into commercial managed care systems. As policy makers consider such alternatives, a persistent question is, apart from the disabled within Medicaid, do younger Medicaid enrollees represent a different insurance risk than people of similar age and sex within private insurance pools? We use 1994 data from Georgia, Mississippi, and California to assess relative payment levels, resource use/costs, and risk-adjusted utilization of fee-for-service (FFS) Medicaid enrollees versus privately insured people. When resources are valued at private prices, the use by Medicaid enrollees represents a higher cost. After risk adjustment, Medicaid enrollee resource use appears higher than expected for the privately insured only for outpatient facility visits in the southern states and for inpatient days by pregnant women in California Medi-Cal. Indeed, we find evidence that Medicaid enrollees are underserved relative to their health needs. Given the higher dollar value of their resource usage, apparently obtained under FFS at discounted provider rates, and the lack of evidence on significant overuse relative to need, their integration into private provider systems appears challenging.

A biochemical hypothesis explaining the response of enhanced biological phosphorus removal biomass to organic substrates.

Anaerobic/aerobic batch experiments were conducted with a variety of volatile fatty (VFAs) and amino acids on two sequencing batch reactor populations displaying enhanced biological phosphorus removal. The batch experiments were consistent between the two systems and with the past literature: acetic and isovaleric acid were the most efficient substrates, and propionic acid was the least efficient of the 2-5 carbon VFAs (lack of acclimation was ruled out). A survey of the engineering and biochemical literature revealed that both acetic and isovaleric acid resulted in a negative reaction redox balance (i.e. it requires reducing equivalents such as NADH2) during their biotransformation to polyhydroxyalkanoates (PHAs). In addition, the survey indicated that acetic and isovaleric acid resulted in 3HB rather than 3HV or 3H2MV formation. Two possible hypotheses were put forward for evaluation: (1) it was hypothesized that a negative intracellular redox balance might result in higher PHA content since PHA biosynthesis could be sustained under anaerobic conditions (no NADH2 build up), and/or (2) it was hypothesized that 3HB resulted in greater P-uptake than other PHA forms such as 3HV.