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Policy Prescriptions

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87 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
https://www.readbyqxmd.com/read/28341637/the-tax-exclusion-for-employer-sponsored-insurance-is-not-regressive-but-what-is-it
#1
Joseph White
Conventional wisdom says that the tax exclusion for employer-sponsored health insurance (ESI) is "regressive and therefore unfair." Yet, by the standard definition of regressive tax policy, the conventional view is almost certainly false. It confuses the absolute size of the tax exclusion with its proportional effect on income. The error results from paying attention only to the marginal tax rate applied to ESI benefits as a portion of income and ignoring the fact that benefits are normally a much larger share of income for people with lower wages...
March 24, 2017: Journal of Health Politics, Policy and Law
https://www.readbyqxmd.com/read/28554214/battling-the-chargemaster-a-simple-remedy-to-balance-billing-for-unavoidable-out-of-network-care
#2
Barak D Richman, Nick Kitzman, Arnold Milstein, Kevin A Schulman
OBJECTIVES: To develop an effective legal mechanism to combat chargemaster abuses and to facilitate price transparency. STUDY DESIGN: Applying legal doctrines to out-of-network (OON) billing disputes. METHODS: We reviewed rudimentary contract law and examined the law's handling of contracts where prices have not been specified in advance. These cases are the controlling authority to guide courts, handling of surprise and OON billing problems...
April 1, 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/28228484/in-mexico-evidence-of-sustained-consumer-response-two-years-after-implementing-a-sugar-sweetened-beverage-tax
#3
M Arantxa Colchero, Juan Rivera-Dommarco, Barry M Popkin, Shu Wen Ng
Mexico implemented a 1 peso per liter excise tax on sugar-sweetened beverages on January 1, 2014, and a previous study found a 6 percent reduction in purchases of taxed beverages in 2014. In this study we estimated changes in beverage purchases for 2014 and 2015. We used store purchase data for 6,645 households from January 2012 to December 2015. Changes in purchases of taxed and untaxed beverages in the study period were estimated using two models, which compared 2014 and 2015 purchases with predicted (counterfactual) purchases based on trends in 2012-13...
March 1, 2017: Health Affairs
https://www.readbyqxmd.com/read/28234756/a-comparison-of-nurse-practitioners-physician-assistants-and-primary-care-physicians-patterns-of-practice-and-quality-of-care-in-health-centers
#4
COMPARATIVE STUDY
Ellen T Kurtzman, Burt S Barnow
BACKGROUND: Under the Affordable Care Act, the number and capacity of community health centers (HCs) is growing. Although the majority of HC care is provided by primary care physicians (PCMDs), a growing proportion is delivered by nurse practitioners (NPs) and physician assistants (PAs); yet, little is known about how these clinicians' care compares in this setting. OBJECTIVES: To compare the quality of care and practice patterns of NPs, PAs, and PCMDs in HCs. RESEARCH DESIGN: Using 5 years of data (2006-2010) from the HC subsample of the National Ambulatory Medical Care Survey and multivariate regression analysis, we estimated the impact of receiving NP-delivered or PA-delivered care versus PCMD-delivered care...
June 2017: Medical Care
https://www.readbyqxmd.com/read/28385030/consumer-directed-health-plans-do-doctors-and-nurses-buy-in
#5
Lucinda B Leung, José J Escarce
OBJECTIVES: Aiming to increase healthcare value, consumer-directed health plans (CDHPs)-high-deductible health insurance plus a personal spending account-equip enrollees with decision-support tools and expose them to the financial implications of their medical decisions. This study examines whether medically knowledgeable consumers are more or less likely to select a CDHP than individuals without medical knowledge. STUDY DESIGN: Using University of California Los Angeles (UCLA) human resources data, our observational cross-sectional study analyzed the health plan enrollment choices of 3552 faculty and 8429 staff employees...
March 1, 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/28971922/early-medicaid-expansion-associated-with-reduced-payday-borrowing-in-california
#6
Heidi Allen, Ashley Swanson, Jialan Wang, Tal Gross
We examined the impact of California's early Medicaid expansion under the Affordable Care Act on the use of payday loans, a form of high-interest borrowing used by low- and middle-income Americans. Using a data set for the period 2009-13 (roughly twenty-four months before and twenty-four months after the 2011-12 Medicaid expansion) that covered the universe of payday loans from five large payday lenders with locations around the United States, we used a difference-in-differences research design to assess the effect of the expansion on payday borrowing, comparing trends in early-expansion counties in California to those in counties nationwide that did not expand early...
October 1, 2017: Health Affairs
https://www.readbyqxmd.com/read/28671929/up-to-date-on-preventive-care-services-under-affordable-care-act-a-trend-analysis-from-meps-2007-2014
#7
Young-Rock Hong, Ara Jo, Arch G Mainous
BACKGROUND: The utilization of preventive care services has been less than optimal. As part of an effort to address this, the Affordable Care Act (ACA) mandated that private health insurance plans cover evidence-based preventive services. OBJECTIVES: To evaluate whether the provisions of ACA have increased being up-to-date on recommended preventive care services among privately insured individuals aged 18-64. RESEARCH DESIGN: Multivariate linear regression models were used to examine trends in prevalence of being up-to-date on selected preventive services, diagnosis of health conditions, and health expenditures between pre-ACA (2007-2010) and post-ACA (2011-2014)...
August 2017: Medical Care
https://www.readbyqxmd.com/read/28517042/the-impact-of-the-aca-medicaid-expansions-on-health-insurance-coverage-through-2015-and-coverage-disparities-by-age-race-ethnicity-and-gender
#8
George L Wehby, Wei Lyu
OBJECTIVE: Examine the ACA Medicaid expansion effects on Medicaid take-up and private coverage through 2015 and coverage disparities by age, race/ethnicity, and gender. DATA SOURCES: 2011-2015 American Community Survey for 3,137,989 low-educated adults aged 19-64 years. STUDY DESIGN: Difference-in-differences regressions accounting for national coverage trends and state fixed effects. PRINCIPAL FINDINGS: Expansion effects doubled in 2015 among low-educated adults, with a nearly 8 percentage-point increase in Medicaid take-up and 6 percentage-point decline in uninsured rate...
May 18, 2017: Health Services Research
https://www.readbyqxmd.com/read/28747321/the-affordable-care-act-reduced-socioeconomic-disparities-in-health-care-access
#9
Kevin Griffith, Leigh Evans, Jacob Bor
The United States has the largest socioeconomic disparities in health care access of any wealthy country. We assessed changes in these disparities in the United States under the Affordable Care Act (ACA). We used survey data for the period 2011-15 from the Behavioral Risk Factor Surveillance System to assess trends in insurance coverage, having a personal doctor, and avoiding medical care due to cost. All analyses were stratified by household income, education level, employment status, and home ownership status...
July 26, 2017: Health Affairs
https://www.readbyqxmd.com/read/28558093/variation-in-emergency-department-vs-internal-medicine-excess-charges-in-the-united-states
#10
Tim Xu, Angela Park, Ge Bai, Sarah Joo, Susan M Hutfless, Ambar Mehta, Gerard F Anderson, Martin A Makary
Importance: Uninsured and insured but out-of-network emergency department (ED) patients are often billed hospital chargemaster prices, which exceed amounts typically paid by insurers. Objective: To examine the variation in excess charges for services provided by emergency medicine and internal medicine physicians. Design, Setting, and Participants: Retrospective analysis was conducted of professional fee payment claims made by the Centers for Medicare & Medicaid Services for all services provided to Medicare Part B fee-for-service beneficiaries in calendar year 2013...
August 1, 2017: JAMA Internal Medicine
https://www.readbyqxmd.com/read/28640679/crash-fatality-rates-after-recreational-marijuana-legalization-in-washington-and-colorado
#11
Jayson D Aydelotte, Lawrence H Brown, Kevin M Luftman, Alexandra L Mardock, Pedro G R Teixeira, Ben Coopwood, Carlos V R Brown
OBJECTIVES: To evaluate motor vehicle crash fatality rates in the first 2 states with recreational marijuana legalization and compare them with motor vehicle crash fatality rates in similar states without recreational marijuana legalization. METHODS: We used the US Fatality Analysis Reporting System to determine the annual numbers of motor vehicle crash fatalities between 2009 and 2015 in Washington, Colorado, and 8 control states. We compared year-over-year changes in motor vehicle crash fatality rates (per billion vehicle miles traveled) before and after recreational marijuana legalization with a difference-in-differences approach that controlled for underlying time trends and state-specific population, economic, and traffic characteristics...
August 2017: American Journal of Public Health
https://www.readbyqxmd.com/read/28874495/sustained-gains-in-coverage-access-and-affordability-under-the-aca-a-2017-update
#12
Sharon K Long, Lea Bart, Michael Karpman, Adele Shartzer, Stephen Zuckerman
The significant gains in health insurance coverage and improvements in health care access and affordability that followed the implementation of the key coverage provisions of the Affordable Care Act in 2014 have persisted into 2017. Adults in all parts of the country, of all ages, and across all income groups have benefited from a large and sustained increase in the percentage of the US population that has health insurance. The gains have been particularly striking among low- and moderate-income Americans living in states that expanded Medicaid...
September 1, 2017: Health Affairs
https://www.readbyqxmd.com/read/28874480/corporate-investors-increased-common-ownership-in-hospitals-and-the-postacute-care-and-hospice-sectors
#13
Annabelle C Fowler, David C Grabowski, Robert J Gambrel, Haiden A Huskamp, David G Stevenson
The sharing of investors across firms is a new antitrust focus because of its potential negative effects on competition. Historically, the ability to track common investors across the continuum of health care providers has been limited. Thus, little is known about common investor ownership structures that might exist across health care delivery systems and how these linkages have evolved over time. We used data from the Provider Enrollment, Chain, and Ownership System of the Centers for Medicare and Medicaid Services to identify common investor ownership linkages across the acute care, postacute care, and hospice sectors within the same geographic markets...
September 1, 2017: Health Affairs
https://www.readbyqxmd.com/read/28918678/the-affordable-care-act-medicaid-expansions-and-personal-finance
#14
Kyle J Caswell, Timothy A Waidmann
Using a novel data set from a major credit bureau, we examine the early effects of the Affordable Care Act Medicaid expansions on personal finance. We analyze less common events such as personal bankruptcy, and more common occurrences such as medical collection balances, and change in credit scores. We estimate triple-difference models that compare individual outcomes across counties that expanded Medicaid versus counties that did not, and across expansion counties that had more uninsured residents versus those with fewer...
September 1, 2017: Medical Care Research and Review: MCRR
https://www.readbyqxmd.com/read/28874489/most-marketplace-plans-included-at-least-25%C3%A2-percent-of-local-area-physicians-but-enrollment-disparities-remained
#15
Aditi P Sen, Lena M Chen, Donald F Cox, Arnold M Epstein
The Affordable Care Act allows commercial insurers participating in the Marketplaces to vary the size of their provider networks as long as the providers are "sufficient" in numbers and types. Concerns have been growing over the increasing use of restricted-provider or narrow networks in Marketplace plans because of their implications for reduced access to care, but little is known about the breadth and stability of these networks over time or what types of enrollees choose such plans. Using national data, we found that in 2016, 60 percent of provider networks in plans offered in the federally facilitated Marketplaces included at least one-quarter of local-area physicians, and that consumers' access to broad-network plans remained stable between 2015 and 2016...
September 1, 2017: Health Affairs
https://www.readbyqxmd.com/read/28264954/value-based-insurance-design-benefit-offsets-reductions-in-medication-adherence-associated-with-switch-to-deductible-plan
#16
Mary E Reed, E Margaret Warton, Eileen Kim, Matthew D Solomon, Andrew J Karter
Enrollment in high-deductible health plans is increasing out-of-pocket spending. But innovative plans that pair deductibles with value-based insurance designs can help preserve low-cost access to high-value treatments for patients by aligning coverage with clinical value. Among adults in high-deductible health plans who were prescribed medications for chronic conditions, we examined what impact a value-based pharmacy benefit that offered free chronic disease medications had on medication adherence. Overall, we found that the value-based plan offset reductions in medication adherence associated with switching to a deductible plan...
March 1, 2017: Health Affairs
https://www.readbyqxmd.com/read/28493481/hospital-and-health-insurance-markets-concentration-and-inpatient-hospital-transaction-prices-in-the-u-s-health-care-market
#17
Seidu Dauda
OBJECTIVE: To examine the effects of hospital and insurer markets concentration on transaction prices for inpatient hospital services. DATA SOURCES: Measures of hospital and insurer markets concentration derived from American Hospital Association and HealthLeaders-InterStudy data are linked to 2005-2008 inpatient administrative data from Truven Health MarketScan Databases. STUDY DESIGN: Uses a reduced-form price equation, controlling for cost and demand shifters and accounting for possible endogeneity of market concentration using instrumental variables (IV) technique...
May 11, 2017: Health Services Research
https://www.readbyqxmd.com/read/28679807/end-of-life-medical-spending-in-last-twelve-months-of-life-is-lower-than-previously-reported
#18
Eric B French, Jeremy McCauley, Maria Aragon, Pieter Bakx, Martin Chalkley, Stacey H Chen, Bent J Christensen, Hongwei Chuang, Aurelie Côté-Sergent, Mariacristina De Nardi, Elliott Fan, Damien Échevin, Pierre-Yves Geoffard, Christelle Gastaldi-Ménager, Mette Gørtz, Yoko Ibuka, John B Jones, Malene Kallestrup-Lamb, Martin Karlsson, Tobias J Klein, Grégoire de Lagasnerie, Pierre-Carl Michaud, Owen O'Donnell, Nigel Rice, Jonathan S Skinner, Eddy van Doorslaer, Nicolas R Ziebarth, Elaine Kelly
Although end-of-life medical spending is often viewed as a major component of aggregate medical expenditure, accurate measures of this type of medical spending are scarce. We used detailed health care data for the period 2009-11 from Denmark, England, France, Germany, Japan, the Netherlands, Taiwan, the United States, and the Canadian province of Quebec to measure the composition and magnitude of medical spending in the three years before death. In all nine countries, medical spending at the end of life was high relative to spending at other ages...
July 1, 2017: Health Affairs
https://www.readbyqxmd.com/read/28641909/effect-of-the-affordable-care-act-medicaid-expansion-on-emergency-department-visits-evidence-from-state-level-emergency-department-databases
#19
REVIEW
Sayeh Nikpay, Seth Freedman, Helen Levy, Tom Buchmueller
STUDY OBJECTIVE: We assess whether the expansion of Medicaid under the Patient Protection and Affordable Care Act (ACA) results in changes in emergency department (ED) visits or ED payer mix. We also test whether the size of the change in ED visits depends on the change in the size of the Medicaid population. METHODS: Using all-capture, longitudinal, state data from the Agency for Healthcare Research and Quality's Fast Stats program, we implemented a difference-in-difference analysis, which compared changes in ED visits per capita and the share of ED visits by payer (Medicaid, uninsured, and private insurance) in 14 states that did and 11 states that did not expand Medicaid in 2014...
August 2017: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/28655034/the-relationship-of-health-insurance-and-mortality-is-lack-of-insurance-deadly
#20
REVIEW
Steffie Woolhandler, David U Himmelstein
About 28 million Americans are currently uninsured, and millions more could lose coverage under policy reforms proposed in Congress. At the same time, a growing number of policy leaders have called for going beyond the Patient Protection and Affordable Care Act to a single-payer national health insurance system that would cover every American. These policy debates lend particular salience to studies evaluating the health effects of insurance coverage. In 2002, an Institute of Medicine review concluded that lack of insurance increases mortality, but several relevant studies have appeared since that time...
September 19, 2017: Annals of Internal Medicine
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