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Policy Prescriptions

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45 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/28176307/do-people-with-health-insurance-coverage-who-live-in-areas-with-high-uninsurance-rates-pay-more-for-emergency-department-visits
#1
James B Kirby, Joel W Cohen
OBJECTIVE: To investigate the relationship between the percent uninsured in a county and expenditures associated with the typical emergency department visit. DATA SOURCES: The Medical Expenditure Panel Survey linked to county-level data from the American Community Survey, the Healthcare Cost and Utilization Project, and the Area Health Resources Files. STUDY DESIGN: We use a nationally representative sample of emergency department visits that took place between 2009 and 2013 to estimate the association between the percent uninsured in counties and the amount paid for a typical visit...
February 7, 2017: Health Services Research
https://www.readbyqxmd.com/read/27385230/marketplace-subsidies-changing-the-family-glitch-reduces-family-health-spending-but-increases-government-costs
#2
Matthew Buettgens, Lisa Dubay, Genevieve M Kenney
Under the Affordable Care Act, if one family member has an employer offer of single coverage deemed to be affordable-that is, costing less than 9.66 percent of family income in 2016-then all family members are ineligible for tax credits for Marketplace coverage, even if the cost of providing coverage to the whole family is greater than 9.66 percent of income. More than six million people live in such families and as a result are ineligible for premium tax credits. These families face premiums that can amount to 15...
July 1, 2016: Health Affairs
https://www.readbyqxmd.com/read/27322350/pharmaceutical-industry-sponsored-meals-and-physician-prescribing-patterns-for-medicare-beneficiaries
#3
Colette DeJong, Thomas Aguilar, Chien-Wen Tseng, Grace A Lin, W John Boscardin, R Adams Dudley
IMPORTANCE: The association between industry payments to physicians and prescribing rates of the brand-name medications that are being promoted is controversial. In the United States, industry payment data and Medicare prescribing records recently became publicly available. OBJECTIVE: To study the association between physicians' receipt of industry-sponsored meals, which account for roughly 80% of the total number of industry payments, and rates of prescribing the promoted drug to Medicare beneficiaries...
August 1, 2016: JAMA Internal Medicine
https://www.readbyqxmd.com/read/28213393/the-racial-divide-in-state-medicaid-expansions
#4
Colleen M Grogan, Sunggeun Ethan Park
This study considers five important questions related to the role of race in state-level public support for the Medicaid expansion: (1) whether public support for the Medicaid expansion varies across the American states; (2) whether public support is positively related to state adoption; (3) whether this support is racialized; (4) whether, if racialized, there is evidence of more state responsiveness to white support than to nonwhite (black and/or Latino) support; and (5) does the size of the nonwhite population matter more when white support is relatively low? Our findings suggest that while public support for the Medicaid expansion is high at the state level, especially in comparison to public support for the ACA, there are important variations across the states...
June 2017: Journal of Health Politics, Policy and Law
https://www.readbyqxmd.com/read/27569108/increased-emergency-department-use-in-illinois-after-implementation-of-the-patient-protection-and-affordable-care-act
#5
Scott M Dresden, Emilie S Powell, Raymond Kang, Megan McHugh, Andrew J Cooper, Joe Feinglass
STUDY OBJECTIVE: We examine emergency department (ED) use and hospitalizations through the ED after Patient Protection and Affordable Care Act (ACA) health insurance expansion in Illinois, a Medicaid expansion state. METHODS: Using statewide hospital administrative data from 2011 through 2015 from 201 nonfederal Illinois hospitals for patients aged 18 to 64 years, mean monthly ED visits were compared before and after ACA implementation by disposition from the ED and primary payer...
February 2017: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/28264943/innovative-home-visit-models-associated-with-reductions-in-costs-hospitalizations-and-emergency-department-use
#6
Sarah Ruiz, Lynne Page Snyder, Christina Rotondo, Caitlin Cross-Barnet, Erin Murphy Colligan, Katherine Giuriceo
While studies of home-based care delivered by teams led by primary care providers have shown cost savings, little is known about outcomes when practice-extender teams-that is, teams led by registered nurses or lay health workers-provide home visits with similar components (for example, care coordination and education). We evaluated findings from five models funded by Health Care Innovation Awards of the Centers for Medicare and Medicaid Services. Each model used a mix of different components to strengthen connections to primary care among fee-for-service Medicare beneficiaries with multiple chronic conditions; these connections included practice-extender home visits...
March 1, 2017: Health Affairs
https://www.readbyqxmd.com/read/27442786/-i-broke-my-ankle-access-to-orthopedic-follow-up-care-by-insurance-status
#7
Laura N Medford-Davis, Fred Lin, Alexandra Greenstein, Karin V Rhodes
OBJECTIVES: While the Affordable Care Act seeks to reduce emergency department (ED) visits for outpatient-treatable conditions, it remains unclear whether Medicaid patients or the uninsured have adequate access to follow-up care. The goal of this study was to determine the availability of follow-up orthopedic care by insurance status. METHODS: Using simulated patient methodology, all 102 eligible general orthopedic practices in Dallas-Fort Worth, Texas, were contacted twice by a caller requesting follow-up for an ankle fracture diagnosed in a local ED using a standardized script that differed by insurance status...
January 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28207344/the-future-of-the-affordable-care-act-and-insurance-coverage
#8
Sherry Glied, Adlan Jackson
We describe the patterns of coverage gains associated with the Affordable Care Act (ACA) expansions and use these patterns to assess the potential impact of alternative repeal or repeal and replace strategies because Congress and the president are weighing options to repeal or replace the ACA. We find that specific provisions of the ACA, including the Medicaid expansion and the structure of premium subsidies, have been associated with large and robust gains in insurance coverage. We evaluate the impact of retaining dependent coverage and high-risk pool provisions and show, on the basis of the ACA experience, that these provisions would have little effect on coverage...
April 2017: American Journal of Public Health
https://www.readbyqxmd.com/read/27856648/in-new-survey-of-eleven-countries-us-adults-still-struggle-with-access-to-and-affordability-of-health-care
#9
Robin Osborn, David Squires, Michelle M Doty, Dana O Sarnak, Eric C Schneider
Surveys of patients' experiences with health care services can reveal how well a country's health system is meeting the needs of its population. Using data from a 2016 survey conducted in eleven countries-Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States-we found that US adults reported poor health and well-being and were the most likely to experience material hardship. The United States trailed other countries in making health care affordable and ranked poorly on providing timely access to medical care (except specialist care)...
December 1, 2016: Health Affairs
https://www.readbyqxmd.com/read/27982667/accountable-care-organization-hospitals-differ-in-health-it-capabilities
#10
Daniel M Walker, Arthur M Mora, Ann Scheck McAlearney
OBJECTIVES: The aim of this study was to evaluate health information technology (IT) adoption in hospitals participating in accountable care organizations (ACOs) and compare this adoption to non-ACO hospitals. STUDY DESIGN: A cross-sectional sample of US nonfederal, acute care hospitals with data from 3 matched sources: the 2013 American Hospital Association (AHA) Annual Survey, the 2013 AHA Survey of Care Systems and Payments (CSP), and the 2014 AHA Information Technology Supplement...
December 2016: American Journal of Managed Care
https://www.readbyqxmd.com/read/28069842/most-newly-insured-people-in-2014-were-long-term-uninsured
#11
Sandra L Decker, Brandy J Lipton
In 2014-after the implementation of most of the Affordable Care Act provisions, including Medicaid expansions in some states and subsidies to purchase Marketplace coverage in all states-adults who had been uninsured for more than three years represented a larger share of the newly insured, compared to adults who had been insured for shorter periods of time.
January 1, 2017: Health Affairs
https://www.readbyqxmd.com/read/27920322/patients-who-choose-primary-care-physicians-based-on-low-office-visit-price-can-realize-broader-savings
#12
Ateev Mehrotra, Peter J Huckfeldt, Amelia M Haviland, Laura Gascue, Neeraj Sood
Price transparency initiatives encourage patients to save money by choosing physicians with a relatively low price per office visit. Given that the price of such visits represents a small fraction of total spending, the extent of the savings from choosing such physicians has not been clear. Using a national sample of commercial claims data, we compared the care received by patients of high- and low-price primary care physicians. The median price for an established patient's office visit was $60 among low-price physicians and $86 among high-price physicians (price was calculated as reimbursement plus out-of-pocket spending)...
December 1, 2016: Health Affairs
https://www.readbyqxmd.com/read/27927839/does-medicare-advantage-reduce-racial-disparity-in-30-day-rehospitalization-for-medicare-beneficiaries
#13
Yue Li, Xi Cen, Xueya Cai, Dongliang Wang, Caroline Pinto Thirukumaran, Laurent G Glance
This study determined potential racial and ethnic disparities in risk for all-cause 30-day readmission among traditional Medicare (TM) and Medicare Advantage (MA) beneficiaries initially hospitalized for acute myocardial infarction, congestive heart failure, or pneumonia. Our analyses of New York State hospital administrative data between 2009 and 2012 found that overall 30-day readmission rate declined from 22.0% in 2009 to 20.7% in 2012 for TM beneficiaries, and from 20.2% in 2009 to 17.9% in 2012 for MA beneficiaries...
December 6, 2016: Medical Care Research and Review: MCRR
https://www.readbyqxmd.com/read/27367865/impact-of-aca-insurance-coverage-expansion-on-perforated-appendix-rates-among-young-adults
#14
John W Scott, John A Rose, Thomas C Tsai, Cheryl K Zogg, Mark G Shrime, Benjamin D Sommers, Ali Salim, Adil H Haider
BACKGROUND: The 2010 Dependent Coverage Provision (DCP) of the Affordable Care Act allowed young adults to remain on their parents' health insurance plans until age 26 years. Although the provision improved coverage and survey-reported access to care, little is known regarding its impact on timely access for acute conditions. This study aims to assess changes in insurance coverage and perforation rates among young adults with acute appendicitis-an established metric for population-level health care access-after the DCP...
September 2016: Medical Care
https://www.readbyqxmd.com/read/27922910/impact-of-medicare-s-nonpayment-program-on-hospital-acquired-conditions
#15
Caroline P Thirukumaran, Laurent G Glance, Helena Temkin-Greener, Meredith B Rosenthal, Yue Li
BACKGROUND: Medicare's Nonpayment Program of 2008 (hereafter called Program) withholds hospital reimbursement for costs related to hospital-acquired conditions (HACs). Little is known whether a hospital's Medicare patient load [quantified by the hospital's Medicare utilization ratio (MUR), which is the proportion of inpatient days financed by Medicare] influences its response to the Program. OBJECTIVE: To determine whether the Program was associated with changes in HAC incidence, and whether this association varies across hospitals with differential Medicare patient load...
May 2017: Medical Care
https://www.readbyqxmd.com/read/27997244/effect-of-medicaid-expansion-on-workforce-participation-for-people-with-disabilities
#16
Jean P Hall, Adele Shartzer, Noelle K Kurth, Kathleen C Thomas
OBJECTIVES: To use data from the Health Reform Monitoring Survey (HRMS) to examine differences in employment among community-living, working-age adults (aged 18-64 years) with disabilities who live in Medicaid expansion states and nonexpansion states. METHODS: Analyses used difference-in-differences to compare trends in pooled, cross-sectional estimates of employment by state expansion status for 2740 HRMS respondents reporting a disability, adjusting for individual and state characteristics...
February 2017: American Journal of Public Health
https://www.readbyqxmd.com/read/27920320/low-income-working-families-with-employer-sponsored-insurance-turn-to-public-insurance-for-their-children
#17
Douglas Strane, Benjamin French, Jennifer Eder, Charlene A Wong, Kathleen G Noonan, David M Rubin
Many families rely on employer-sponsored health insurance for their children. However, the rise in the cost of such insurance has outpaced growth in family income, potentially making public insurance (Medicaid or the Children's Health Insurance Plan) an attractive alternative for affordable dependent coverage. Using data for 2008-13 from the Medical Expenditure Panel Survey, we quantified the coverage rates for children from low- or moderate-income households in which a parent was offered employer-sponsored insurance...
December 1, 2016: Health Affairs
https://www.readbyqxmd.com/read/27702958/marketplace-plans-with-narrow-physician-networks-feature-lower-monthly-premiums-than-plans-with-larger-networks
#18
Daniel Polsky, Zuleyha Cidav, Ashley Swanson
The introduction of health insurance Marketplaces under the Affordable Care Act has been associated with growth of restricted provider networks. The value of this plan design strategy, including its association with lower premiums, is uncertain. We used data from all silver plans offered in the 2014 health insurance exchanges in the fifty states and the District of Columbia to estimate the association between the breadth of a provider network and plan premiums. We found that within a market, for plans of otherwise equivalent design and controlling for issuer-specific pricing strategy, a plan with an extra-small network had a monthly premium that was 6...
October 1, 2016: Health Affairs
https://www.readbyqxmd.com/read/27854531/health-and-social-conditions-of-the-poorest-versus-wealthiest-counties-in-the-united-states
#19
Olivia Egen, Kate Beatty, David J Blackley, Katie Brown, Randy Wykoff
OBJECTIVES: To more clearly articulate, and more graphically demonstrate, the impact of poverty on various health outcomes and social conditions by comparing the poorest counties to the richest counties in the United States and to other countries in the world. METHODS: We used 5-year averages for median household income to form the 3141 US counties into 50 new "states"-each representing 2% of the counties in the United States (62 or 63 counties each). We compared the poorest and wealthiest "states...
January 2017: American Journal of Public Health
https://www.readbyqxmd.com/read/27854535/gain-in-insurance-coverage-and-residual-uninsurance-under-the-affordable-care-act-texas-2013-2016
#20
Stephen Pickett, Elena Marks, Vivian Ho
OBJECTIVES: To examine the effects of the Affordable Care Act's (ACA's) Marketplace on Texas residents and determine which population subgroups benefited the most and which the least. METHODS: We analyzed insurance coverage rates among nonelderly Texas adults using the Health Reform Monitoring Survey-Texas from September 2013, just before the first open enrollment period in the Marketplace, through March 2016. RESULTS: Texas has experienced a roughly 6-percentage-point increase in insurance coverage (from 74...
January 2017: American Journal of Public Health
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