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Policy Prescriptions

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114 papers 0 to 25 followers Articles under review for www.policyrx.org -- a health policy and health services research literature review for clinicians, healthcare executives, and policymakers. Attend our Annual Symposium -- register at www.policyrx.com.
By Cedric Dark MD, MPH, FACEP, FAAEM
https://www.readbyqxmd.com/read/29364736/medicaid-versus-marketplace-coverage-for-near-poor-adults-effects-on-out-of-pocket-spending-and-coverage
#1
Fredric Blavin, Michael Karpman, Genevieve M Kenney, Benjamin D Sommers
In states that expanded Medicaid eligibility under the Affordable Care Act, nonelderly near-poor adults-those with family incomes of 100-138 percent of the federal poverty level-are generally eligible for Medicaid, with no premiums and minimal cost sharing. In states that did not expand eligibility, these adults may qualify for premium tax credits to purchase Marketplace plans that have out-of-pocket premiums and cost-sharing requirements. We used data for 2010-15 to estimate the effects of Medicaid expansion on coverage and out-of-pocket expenses, compared to the effects of Marketplace coverage...
February 2018: Health Affairs
https://www.readbyqxmd.com/read/28928263/health-benefits-in-2017-stable-coverage-workers-faced-considerable-variation-in-costs
#2
Gary Claxton, Matthew Rae, Michelle Long, Anthony Damico, Heidi Whitmore, Gregory Foster
The annual Kaiser Family Foundation/Health Research and Educational Trust Employer Health Benefits Survey found that in 2017, average annual premiums (employer and worker contributions combined) rose 4 percent for single coverage, to $6,690, and 3 percent for family coverage, to $18,764. Covered workers contributed 18 percent of the premium for single coverage and 31 percent for family coverage, on average, although there was considerable variation around these averages. For covered workers in small firms, 10 percent did not make a premium contribution for family coverage, while 36 percent made a contribution of more than half of their premium...
October 1, 2017: Health Affairs
https://www.readbyqxmd.com/read/29355927/early-impact-of-the-affordable-care-act-coverage-expansion-on-safety-net-hospital-inpatient-payer-mix-and-market-shares
#3
Vivian Y Wu, Kathryn R Fingar, H Joanna Jiang, Raynard Washington, Andrew W Mulcahy, Eli Cutler, Gary Pickens
OBJECTIVE: To examine the impact of the Affordable Care Act's coverage expansion on safety-net hospitals (SNHs). STUDY SETTING: Nine Medicaid expansion states. STUDY DESIGN: Differences-in-differences (DID) models compare payer-specific pre-post changes in inpatient stays of adults aged 19-64 years at SNHs and non-SNHs. DATA COLLECTION METHODS: 2013-2014 Healthcare Cost and Utilization Project State Inpatient Databases...
January 21, 2018: Health Services Research
https://www.readbyqxmd.com/read/29181542/association-of-clinician-denial-of-patient-requests-with-patient-satisfaction
#4
Anthony Jerant, Joshua J Fenton, Richard L Kravitz, Daniel J Tancredi, Elizabeth Magnan, Klea D Bertakis, Peter Franks
Importance: Prior studies suggesting clinician fulfillment or denial of requests affects patient satisfaction included limited adjustment for patient confounders. The studies also did not examine distinct request types, yet patient expectations and clinician fulfillment or denial might vary among request types. Objective: To examine how patient satisfaction with the clinician is associated with clinician denial of distinct types of patient requests, adjusting for patient characteristics...
January 1, 2018: JAMA Internal Medicine
https://www.readbyqxmd.com/read/28873133/distribution-of-medical-education-debt-by-specialty-2010-2016
#5
Justin Grischkan, Benjamin P George, Krisda Chaiyachati, Ari B Friedman, E Ray Dorsey, David A Asch
No abstract text is available yet for this article.
October 1, 2017: JAMA Internal Medicine
https://www.readbyqxmd.com/read/29058316/does-enrollment-in-high-deductible-health-plans-encourage-price-shopping
#6
Xinke Zhang, Amelia Haviland, Ateev Mehrotra, Peter Huckfeldt, Zachary Wagner, Neeraj Sood
OBJECTIVE: To investigate whether enrollment in high-deductible health plans (HDHPs) led enrollees to choose lower-priced providers for office visits and laboratory tests. STUDY SETTING: Claims data from more than 40 large employers. STUDY DESIGN: We compared the change in price for office visits and laboratory tests for enrollees who switched to HDHPs versus enrollees who remained in traditional plans. We estimated separate models for enrollees who changed providers versus those who remained with the same provider to disentangle the effects of HDHPs on provider choice and negotiated prices...
October 23, 2017: Health Services Research
https://www.readbyqxmd.com/read/28069138/disparities-in-access-to-trauma-care-in-the-united-states-a-population-based-analysis
#7
Brendan G Carr, Ariel J Bowman, Catherine S Wolff, Michael T Mullen, Daniel N Holena, Charles C Branas, Douglas J Wiebe
BACKGROUND: Injury is a major contributor to morbidity and mortality in the United States. Accordingly, expanding access to trauma care is a Healthy People priority. The extent to which disparities in access to trauma care exist in the US is unknown. Our objective was to describe geographic, demographic, and socioeconomic disparities in access to trauma care in the United States. METHODS: Cross-sectional study of the US population in 2010 using small units of geographic analysis and validated estimates of population access to a Level I or II trauma center within 60minutes via ambulance or helicopter...
February 2017: Injury
https://www.readbyqxmd.com/read/27974361/one-in-five-inpatient-emergency-department-cases-may-lead-to-surprise-bills
#8
Christopher Garmon, Benjamin Chartock
A surprise medical bill is a bill from an out-of-network provider that was not expected by the patient or that came from an out-of-network provider not chosen by the patient. In 2014, 20 percent of hospital inpatient admissions that originated in the emergency department (ED), 14 percent of outpatient visits to the ED, and 9 percent of elective inpatient admissions likely led to a surprise medical bill.
January 1, 2017: Health Affairs
https://www.readbyqxmd.com/read/28419487/the-effect-of-medicaid-physician-fee-increases-on-health-care-access-utilization-and-expenditures
#9
Kevin Callison, Binh T Nguyen
OBJECTIVE: To evaluate the effect of Medicaid fee changes on health care access, utilization, and spending for Medicaid beneficiaries. DATA SOURCE: We use the 2008 and 2012 waves of the Medical Expenditure Panel Survey linked to state-level Medicaid-to-Medicare primary care reimbursement ratios obtained through surveys conducted by the Urban Institute. We also incorporate data from the Current Population Survey and the Area Resource Files. STUDY DESIGN: Using a control group made up of the low-income privately insured, we conduct a difference-in-differences analysis to assess the relationship between Medicaid fee changes and access to care, utilization of health care services, and out-of-pocket medical expenditures for Medicaid enrollees...
April 16, 2017: Health Services Research
https://www.readbyqxmd.com/read/29087158/the-effect-of-narrow-network-plans-on-out-of-pocket-cost
#10
Emily Meredith Gillen, Kristen Hassmiller Lich, Laurel Clayton Trantham, Morris Weinberger, Pam Silberman, Mark Holmes
OBJECTIVES: To estimate the effects of selecting a narrow provider network on outpatient utilization and outpatient out-of-pocket (OOP) expenditures among individuals who chose to enroll in a narrow network plan in 2014. STUDY DESIGN: Claims data from a large insurer in the southeastern United States. METHODS: The sample consisted of individuals continuously enrolled for 2 years (2013-2014) who had Affordable Care Act-compliant plans in 2014...
September 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/28971921/high-deductible-health-plans-reduce-health-care-cost-and-utilization-including-use-of-needed-preventive-services
#11
Rajender Agarwal, Olena Mazurenko, Nir Menachemi
Enrollment in high-deductible health plans (HDHPs) has greatly increased in recent years. Policy makers and other stakeholders need the best available evidence about how these plans may affect health care cost and utilization, but the literature has not been comprehensively synthesized. We performed a systematic review of methodologically rigorous studies that examined the impact of HDHPs on health care utilization and costs. The plans were associated with a significant reduction in preventive care in seven of twelve studies and a significant reduction in office visits in six of eleven studies-which in turn led to a reduction in both appropriate and inappropriate care...
October 1, 2017: Health Affairs
https://www.readbyqxmd.com/read/29200347/the-effect-of-medicaid-on-medication-use-among-poor-adults-evidence-from-oregon
#12
Katherine Baicker, Heidi L Allen, Bill J Wright, Amy N Finkelstein
Oregon's 2008 Medicaid expansion significantly increased the use of prescription medications in 2009-10.
December 2017: Health Affairs
https://www.readbyqxmd.com/read/28884818/the-effect-of-medicaid-on-dental-care-of-poor-adults-evidence-from-the-oregon-health-insurance-experiment
#13
Katherine Baicker, Heidi L Allen, Bill J Wright, Sarah L Taubman, Amy N Finkelstein
OBJECTIVE: To evaluate the effect of Medicaid coverage on dental care outcomes, a major health concern for low-income populations. DATA SOURCES: Primary and secondary data on health care use and outcomes for participants in Oregon's 2008 Medicaid lottery. STUDY DESIGN: We used the lottery's random selection to gauge the causal effects of Medicaid on dental care needs, medication, and emergency department visits for dental care. DATA COLLECTION: Data were collected for lottery participants over 2 years, including mail surveys (N = 23,777) and in-person questionnaires (N = 12,229)...
September 8, 2017: Health Services Research
https://www.readbyqxmd.com/read/28874492/newly-eligible-enrollees-in-medicaid-spend-less-and-use-less-care-than-those-previously-eligible
#14
Paul D Jacobs, Genevieve M Kenney, Thomas M Selden
Understanding the health care spending and utilization of various types of Medicaid enrollees is important for assessing the budgetary implications of both expansion and contraction in Medicaid enrollment. Despite the intense debate surrounding the Affordable Care Act (ACA), however, little information is available on the spending and utilization patterns of the nonelderly adult enrollees who became newly eligible for Medicaid under the ACA. Using data for 2012-14 from the Medical Expenditure Panel Survey, we compared health care spending and utilization of newly eligible Medicaid enrollees with those of nondisabled adults who were previously eligible and enrolled...
September 1, 2017: Health Affairs
https://www.readbyqxmd.com/read/27521368/health-information-exchange-associated-with-improved-emergency-department-care-through-faster-accessing-of-patient-information-from-outside-organizations
#15
Jordan Everson, Keith E Kocher, Julia Adler-Milstein
Objective: To assess whether electronic health information exchange (HIE) is associated with improved emergency department (ED) care processes and utilization through more timely clinician viewing of information from outside organizations. Materials and Methods: Our data included 2163 patients seen in the ED of a large academic medical center for whom clinicians requested and viewed outside information from February 14, 2014, to February 13, 2015. Outside information requests w...
April 1, 2017: Journal of the American Medical Informatics Association: JAMIA
https://www.readbyqxmd.com/read/29261240/impact-of-consumer-directed-health-plans-on-low-value-healthcare
#16
Rachel O Reid, Brendan Rabideau, Neeraj Sood
OBJECTIVES: To assess the impact of consumer-directed health plan (CDHP) enrollment on low-value healthcare spending. STUDY DESIGN: We performed a quasi-experimental analysis using insurance claims data from 376,091 patients aged 18 to 63 years continuously enrolled in a plan from a large national commercial insurer from 2011 to 2013. We measured spending on 26 low-value healthcare services that offer unclear or no clinical benefit. METHODS: Employing a difference-in-differences approach, we compared the change in spending on low-value services for patients switching from a traditional health plan to a CDHP with the change in spending on low-value services for matched patients remaining in a traditional plan...
December 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/29200356/marketplace-plans-provide-risk-protection-but-actuarial-values-overstate-realized-coverage-for-most-enrollees
#17
Maria Polyakova, Lynn Mei Hua, M Kate Bundorf
The Affordable Care Act (ACA) has increased the number of Americans with health insurance. Yet many policy makers and consumers have questioned the value of Marketplace plan coverage because of the generally high levels of cost sharing. We simulated out-of-pocket spending for bronze, silver, or gold Marketplace plans (those having actuarial values of 60 percent, 70 percent, and 80 percent, respectively). We found that for the vast majority of consumers, the proportion of covered spending paid by the plans is likely to be far less than their actuarial values, the metric commonly used to convey plan generosity...
December 2017: Health Affairs
https://www.readbyqxmd.com/read/29346003/medicaid-expansion-and-infant-mortality-in-the-united-states
#18
Chintan B Bhatt, Consuelo M Beck-Sagué
OBJECTIVES: To explore the effect of Medicaid expansion on US infant mortality rate. METHODS: We examined data from 2010 to 2016 and 2014 to 2016 to compare infant mortality rates in states and Washington, DC, that accepted the Affordable Care Act Medicaid expansion (Medicaid expansion states) and states that did not (non-Medicaid expansion states), stratifying data by race/ethnicity. RESULTS: Mean infant mortality rate in non-Medicaid expansion states rose (6...
April 2018: American Journal of Public Health
https://www.readbyqxmd.com/read/29309219/understanding-the-relationship-between-medicaid-expansions-and-hospital-closures
#19
Richard C Lindrooth, Marcelo C Perraillon, Rose Y Hardy, Gregory J Tung
Decisions by states about whether to expand Medicaid under the Affordable Care Act (ACA) have implications for hospitals' financial health. We hypothesized that Medicaid expansion of eligibility for childless adults prevents hospital closures because increased Medicaid coverage for previously uninsured people reduces uncompensated care expenditures and strengthens hospitals' financial position. We tested this hypothesis using data for the period 2008-16 on hospital closures and financial performance. We found that the ACA's Medicaid expansion was associated with improved hospital financial performance and substantially lower likelihoods of closure, especially in rural markets and counties with large numbers of uninsured adults before Medicaid expansion...
January 2018: Health Affairs
https://www.readbyqxmd.com/read/28263282/the-affordable-care-act-s-dependent-care-coverage-and-mortality
#20
Chandler McClellan
BACKGROUND: In September 2010, the Affordable Care Act (ACA) enabled young adults to gain insurance coverage under their parents' policies. OBJECTIVE: Assess the impact of the ACA's dependent care coverage expansion on young adult mortality rates. RESEARCH DESIGN: Using the Multiple Cause Mortality public use database for 2008-2013, the impact of the ACA is examined with a difference-in-differences analysis of monthly mortality rates using individuals aged 26-30 as a natural control group for young adults aged 19-25...
May 2017: Medical Care
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