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Semprini J. Medicaid Expansions and Private Insurance 'Crowd-Out' (1999-2019). SOCIAL SCIENCE QUARTERLY 2023; 104:1329-1342. [PMID: 38737786 PMCID: PMC11086973 DOI: 10.1111/ssqu.13318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 10/18/2023] [Indexed: 05/14/2024]
Abstract
Recent Medicaid expansions have rekindled the debate around private insurance "crowd-out". Prior research is limited by short-time horizons and state-specific analyses. Our study overcomes these limitations by evaluating twenty years of Medicaid expansions across the entire United States. We obtain data from the U.S. Census Bureau for all U.S. states and D.C. for private insurance coverage rates of adults 18-64, for years 1999-2019. After estimating a naïve, staggered Two-Way Fixed Effects Difference-in-Differences regression model, we implement four novel econometric methods to diagnose and overcome threats of bias from staggered designs. We also test for pre-treatment differential trends and heterogenous effects over time. Our findings suggest that Medicaid expansion was associated with a 1.5%-point decline in private insurance rates (p < 0.001). We also observe significant heterogeneity over time, with estimates peaking four years after expansion. The importance of a 1-2%-point crowd-out, we leave for future research and debate.
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Affiliation(s)
- Jason Semprini
- University of Iowa College of Public Health; Department of Health Management and Policy
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2
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Hosseini H, Kubavat A. Why Do People of Asian Descent Not Utilize Mental Health Treatments Compared to Other Ethnic Groups in the United States? Hosp Top 2022; 101:260-265. [PMID: 35152845 DOI: 10.1080/00185868.2022.2038748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Racial and ethnic minorities like Asians in the United States are significantly less likely to receive mental health treatment than Caucasians. Using 2012 Behavioral Risk Factor Surveillance System data, we examined the underutilization of mental health treatment in the US and find that being over 65 or 35-44, being unmarried, and being insured were positively associated with mental health treatment utilization, and as mentally unhealthy days increased, the utilization of treatment also increased. The paper offers a discussion on why there is this underutilization of mental health services amongst Asians and what steps can be taken to improve utilization.
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Affiliation(s)
- Hengameh Hosseini
- Department of Healthcare Administration and Human Resources, The University of Scranton, Scranton, PA, USA
| | - Aayush Kubavat
- Department of Healthcare Administration and Human Resources, The University of Scranton, Scranton, PA, USA
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3
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Graaf G, Snowden L, Keyes L. Medicaid Waivers for Youth with Severe Emotional Disturbance: Associations with Public Health Coverage, Unmet Mental Health Needs & Adequacy of Health Coverage. Community Ment Health J 2021; 57:1449-1463. [PMID: 33492561 DOI: 10.1007/s10597-020-00759-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 12/11/2020] [Indexed: 11/24/2022]
Abstract
Home and Community-Based Services (HCBS) Medicaid waivers for Serious Emotional Disturbance (SED) extend Medicaid eligibility to youth who otherwise would be financially ineligible and finance a broad array of highly specialized mental health services specific to the needs of youth with SED. This study examines whether these policies are associated with greater public health insurance coverage among youth with severe mental health diagnoses. It also assesses, among youth with severe mental health diagnoses who have public health coverage, whether waiver policies are associated with reduced reports of unmet mental health treatment need and increased reports of adequate mental health coverage. Analysis uses CMS reported data on state HCBS Medicaid waivers in conjunction with data from the National Survey of Children's Health for the years 2016 through 2018. Multi-level, fixed-effects logistic regression models demonstrate that living in a state with an HCBS Medicaid waiver is associated with significantly increased odds of having public insurance among children with concurrent private health coverage (OR 1.89), reduced odds of unmet mental health needs among youth with public coverage (OR 0.45), but not significantly associated with reported adequacy of mental health insurance coverage.
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Affiliation(s)
- Genevieve Graaf
- School of Social Work, University of Texas at Arlington, Social Work Complex - A, 112D, 211 South Cooper Street, Box 19129, Arlington, TX, 76019, USA.
| | - Lonnie Snowden
- School of Public Health, University of California, Berkeley, USA
| | - Latocia Keyes
- School of Social Work, University of Texas at Arlington, Social Work Complex - A, 112D, 211 South Cooper Street, Box 19129, Arlington, TX, 76019, USA
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4
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Wang SY, Valero-Elizondo J, Ali HJ, Pandey A, Cainzos-Achirica M, Krumholz HM, Nasir K, Khera R. Out-of-Pocket Annual Health Expenditures and Financial Toxicity From Healthcare Costs in Patients With Heart Failure in the United States. J Am Heart Assoc 2021; 10:e022164. [PMID: 33998273 PMCID: PMC8483501 DOI: 10.1161/jaha.121.022164] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background Heart failure (HF) poses a major public health burden in the United States. We examined the burden of out‐of‐pocket healthcare costs on patients with HF and their families. Methods and Results In the Medical Expenditure Panel Survey, we identified all families with ≥1 adult member with HF during 2014 to 2018. Total out‐of‐pocket healthcare expenditures included yearly care‐specific costs and insurance premiums. We evaluated 2 outcomes of financial toxicity: (1) high financial burden—total out‐of‐pocket healthcare expense to postsubsistence income ratio of >20%, and (2) catastrophic financial burden with the ratio of >40%—a bankrupting expense defined by the World Health Organization. There were 788 families in the Medical Expenditure Panel Survey with a member with HF representing 0.54% (95% CI, 0.48%–0.60%) of all families nationally. The overall mean annual out‐of‐pocket healthcare expenses were $4423 (95% CI, $3908–$4939), with medications and health insurance premiums representing the largest categories of cost. Overall, 14% (95% CI, 11%–18%) of families experienced a high burden and 5% (95% CI, 3%–6%) experienced a catastrophic burden. Among the two‐fifths of families considered low income, 24% (95% CI, 18%–30%) experienced a high financial burden, whereas 10% (95% CI, 6%–14%) experienced a catastrophic burden. Low‐income families had 4‐fold greater risk‐adjusted odds of high financial burden (odds ratio [OR] , 3.9; 95% CI, 2.3–6.6), and 14‐fold greater risk‐adjusted odds of catastrophic financial burden (OR, 14.2; 95% CI, 5.1–39.5) compared with middle/high‐income families. Conclusions Patients with HF and their families experience large out‐of‐pocket healthcare expenses. A large proportion encounter financial toxicity, with a disproportionate effect on low‐income families.
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Affiliation(s)
- Stephen Y Wang
- Department of Internal Medicine Yale-New Haven Hospital New Haven CT
| | | | - Hyeon-Ju Ali
- Department of Cardiology Houston Methodist Houston TX
| | - Ambarish Pandey
- Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX
| | | | - Harlan M Krumholz
- Section of Cardiovascular Medicine Department of Internal Medicine Yale School of Medicine New Haven CT.,Center for Outcomes Research and Evaluation Yale-New Haven Hospital New Haven CT
| | - Khurram Nasir
- Department of Cardiology Houston Methodist Houston TX
| | - Rohan Khera
- Section of Cardiovascular Medicine Department of Internal Medicine Yale School of Medicine New Haven CT.,Center for Outcomes Research and Evaluation Yale-New Haven Hospital New Haven CT
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5
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Haschka RE, Schley K, Herwartz H. Provision of health care services and regional diversity in Germany: insights from a Bayesian health frontier analysis with spatial dependencies. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2020; 21:55-71. [PMID: 31493180 DOI: 10.1007/s10198-019-01111-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 08/26/2019] [Indexed: 06/10/2023]
Abstract
The German health care system is among the most patient-oriented systems in Europe. Nevertheless, distinct utilisation patterns, access barriers due to socio-economic profiles, and potentials of misallocation of medical resources lead to disparities in the provision of health care services. We analyse how a possible over- and undersupply of services and the utilisation of and the access to the health care system relate to regional variations in the population's well-being. For this purpose, we employ a recent Bayesian stochastic frontier approach that allows for spatial dependence structures. Our results indicate that patient migration plays an important role in contributing to regional differences in the utilisation of the medical infrastructure. As a consequence, policy should take spatial patterns of health care utilisation into account to improve the allocation of medical resources.
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Shi Q, Castillo F, Viswanathan K, Kupferman F, MacDermid JC. Low Income and Nonadherence to Health Supervision Visits Predispose Children to More Emergency Room Utilization. Glob Pediatr Health 2020; 7:2333794X20938938. [PMID: 35187205 PMCID: PMC8851101 DOI: 10.1177/2333794x20938938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 05/28/2020] [Accepted: 06/10/2020] [Indexed: 11/17/2022] Open
Abstract
Social inequity can have broad health impacts. The purpose of this study was to examine the effects of low income and nonadherence to health supervision visits on emergency room (ER) utilization in Eastern Brooklyn, New York. This study surveyed parents/guardians of children who received routine medical care at Brookdale ambulatory clinics from June 2017 to February 2018. Participants were asked to fill out a questionnaire on social demographics, food insecurity, and relocation. Electronic medical records (EMRs) were reviewed to retrieve numbers of missing health supervision and ER visit in past 12 months. Comorbidity was identified through EMR by International Classification of Diseases. Logistic regression analyses were used to examine the effects of nonadherence to health supervision visits on ER utilization when controlling for demographics, food insecurity, recent moving, and comorbidity. Among 268 participants, 56.0% reported their household income was less than $20,000 annually, 39.6% missed at least 1 health supervision visit, and 31.7% had at least 1 ER visit within the past 12 months. Younger age (adjusted odds ratio [aOR] = 0.92, 95% confidence interval [CI] = 0.86-0.97, P < .01), household income less than $20,000 (aOR = 1.86, 95% CI = 1.02-3.39), preexisting comorbidity (aOR = 2.36, 95% CI = 1.26-4.42), and nonadherence to health supervision visits (aOR = 5.83, 95% CI = 3.21-10.56) were associated with increased ER utilization. Nonadherence to health supervision visits is an independent risk factor and potentially modifiable. Evaluation and remediation should be pursued as a means of improving health outcomes of children in vulnerable circumstances.
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Affiliation(s)
- Qiyun Shi
- McMaster University, Hamilton, Ontario, Canada
- Brookdale University Hospital and Medical Center, New York, NY, USA
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7
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Khera R, Valero-Elizondo J, Okunrintemi V, Saxena A, Das SR, de Lemos JA, Krumholz HM, Nasir K. Association of Out-of-Pocket Annual Health Expenditures With Financial Hardship in Low-Income Adults With Atherosclerotic Cardiovascular Disease in the United States. JAMA Cardiol 2019; 3:729-738. [PMID: 29971325 DOI: 10.1001/jamacardio.2018.1813] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Importance Health insurance is effective in preventing financial hardship from unexpected major health care events. However, it is also essential to assess whether vulnerable patients, particularly those from low-income families, are adequately protected from longitudinal health care costs for common chronic conditions such as atherosclerotic cardiovascular disease (ASCVD). Objective To examine the annual burden of total out-of-pocket health expenses among low-income families that included a member with ASCVD. Design, Setting, and Participants In this cross-sectional study of the Medical Expenditure Panel Survey from January 2006 through December 2015, all families with 1 or more members with ASCVD were identified. Families were classified as low income if they had an income under 200% of the federal poverty limit. Analyses began December 2017. Main Outcomes and Measures Total annual inflation-adjusted out-of-pocket expenses, inclusive of insurance premiums, for all patients with ASCVD. We compared these expenses against annual family incomes. Out-of-pocket expenses of more than 20% and more than 40% of family income defined high and catastrophic financial burden, respectively. Results We identified 22 521 adults with ASCVD, represented in 20 600 families in the Medical Expenditure Panel Survey. They correspond to an annual estimated 23 million or 9.9% of US adults with a mean (SE) age of 65 (0.2) years and included 10.9 million women (47.1%). They were represented in 21 million or 15% of US families. Of these, 8.2 million families (39%) were low income. The mean annual family income was $57 143 (95% CI, $55 377-$58 909), and the mean out-of-pocket expense was $4415 (95% CI, $3735-$3976). While financial burden from health expenses decreased throughout the study, even in 2014 and 2015, low-income families had 3-fold higher odds than mid/high-income families of high financial burden (21.4% vs 7.6%; OR, 3.31; 95% CI, 2.55-4.31) and 9-fold higher odds of catastrophic financial burden (9.8% vs 1.2%; OR, 9.35; 95% CI, 5.39-16.20), representing nearly 2 million low-income families nationally. Further, even among the insured, 1.6 million low-income families (21.8%) experienced high financial burden and 721 000 low-income families (9.8%) experienced catastrophic out-of-pocket health care expenses in 2014 and 2015. Conclusions and Relevance One in 4 low-income families with a member with ASCVD, including those with insurance coverage, experience a high financial burden, and 1 in 10 experience a catastrophic financial burden due to cumulative out-of-pocket health care expenses. To alleviate economic disparities, policy interventions must extend focus to improving not only access, but also quality of coverage, particularly for low-income families.
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Affiliation(s)
- Rohan Khera
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas
| | - Javier Valero-Elizondo
- Center for Healthcare Advancement and Outcomes, Baptist Health South Florida, Miami Beach
| | - Victor Okunrintemi
- Center for Healthcare Advancement and Outcomes, Baptist Health South Florida, Miami Beach
| | - Anshul Saxena
- Center for Healthcare Advancement and Outcomes, Baptist Health South Florida, Miami Beach
| | - Sandeep R Das
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas
| | - James A de Lemos
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas
| | - Harlan M Krumholz
- Center for Outcomes Research and Evaluation, Yale New Haven Health, New Haven, Connecticut.,Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.,Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
| | - Khurram Nasir
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.,Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
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Choi SW, Ramos C, Kim K, Azim SF. The Association of Racial and Ethnic Social Networks with Mental Health Service Utilization Across Minority Groups in the USA. J Racial Ethn Health Disparities 2019; 6:836-850. [DOI: 10.1007/s40615-019-00583-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Revised: 02/21/2019] [Accepted: 03/12/2019] [Indexed: 10/27/2022]
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9
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Smith A, Serban N, Fitzpatrick A. Asthma Prevalence Among Medicaid-Enrolled Children. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018; 7:1207-1213.e4. [PMID: 30339856 DOI: 10.1016/j.jaip.2018.10.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 09/14/2018] [Accepted: 10/04/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND Small-area asthma prevalence measures, which are crucial for targeting interventions, are currently sparsely available for children. OBJECTIVE To provide measures of in-contact asthma prevalence for the 2012 Medicaid child population so as to highlight areas in need of targeted asthma interventions. METHODS Using the 2012 Medicaid Analytic eXtract claims files, we developed 2 prevalence metrics differentiated by persistent and diagnosed asthma. We developed prevalence measures at the state, county, and census tract levels, with statistical inferences to highlight areas of high prevalence where interventions should be focused. We compared the measures with asthma prevalence estimates derived from a sample of the child population that self-reported whether they have been diagnosed with asthma regardless of in-contact asthma. RESULTS A total of 1.98 million (8.1%) and 1.71 million (6.9%) Medicaid-enrolled children were identified with in-contact asthma diagnosis and persistent asthma, respectively. Among 40 states, 17 had lower prevalence estimates for the Medicaid-enrolled children compared with similar child asthma self-reported prevalence estimates from the Centers for Disease Control and Prevention. High-prevalence regions spanned primarily in the southern Midwest region, from Texas to West Virginia and from Illinois to north Florida. CONCLUSION There are large variations in the differences between the self-reported estimates from the Centers for Disease Control and Prevention for the general population and the in-contact estimates for the Medicaid-enrolled children, highlighting potential asthma misdiagnosis in the Medicaid population in many states. Small-area estimates point to areas of high prevalence, consistently throughout the south and southeast.
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Affiliation(s)
- Anna Smith
- H. Milton Stewart School of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta, Ga
| | - Nicoleta Serban
- H. Milton Stewart School of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta, Ga.
| | - Anne Fitzpatrick
- Department of Pediatrics, School of Medicine, Emory University, Atlanta, Ga
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10
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Schley K. Health care service provision in Europe and regional diversity: a stochastic metafrontier approach. HEALTH ECONOMICS REVIEW 2018; 8:11. [PMID: 29855821 PMCID: PMC5981158 DOI: 10.1186/s13561-018-0195-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 05/17/2018] [Indexed: 06/08/2023]
Abstract
UNLABELLED ■■■: In the last decades, demographic change coupled with new and expensive medical innovations have put most health care systems in developed countries under financial pressure. Therefore, ensuring efficient service provision is essential for a sustainable health care system. This paper investigates the performance of regional health care services in six West European countries between 2005 and 2014. We apply a stochastic metafrontier model to capture the different conditions in the health care systems in the countries within the European Union. By means of this approach, it is possible to detect performance differences in the European health care systems subject to different conditions and technologies relative to the potential technology available. The results indicate that regional deprivation plays a key role for the efficiency of health care provision. Furthermore, a pooled model which assumes a similar technology for all countries cannot sufficiently account for differences between countries. Surprisingly, the Scandinavian regions lag behind other regions with respect to the metafrontier. JEL CLASSIFICATION C23, D61, I12, I18, R10.
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Affiliation(s)
- Katharina Schley
- University of Goettingen, Humboldtallee 3, Göttingen, 37073, Germany.
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11
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Chen A, Lo Sasso AT, Richards MR. Supply-side effects from public insurance expansions: Evidence from physician labor markets. HEALTH ECONOMICS 2018; 27:690-708. [PMID: 29194846 DOI: 10.1002/hec.3625] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 08/29/2017] [Accepted: 10/24/2017] [Indexed: 06/07/2023]
Abstract
Medicaid and the Child Health Insurance Programs (CHIP) are key sources of coverage for U.S. children. Established in 1997, CHIP allocated $40 billion of federal funds across the first 10 years but continued support required reauthorization. After 2 failed attempts in Congress, CHIP was finally reauthorized and significantly expanded in 2009. Although much is known about the demand-side policy effects, much less is understood about the policy's impact on providers. In this paper, we leverage a unique physician dataset to examine if and how pediatricians responded to the expansion of the public insurance program. We find that newly trained pediatricians are 8 percentage points more likely to subspecialize and as much as 17 percentage points more likely to enter private practice after the law passed. There is also suggestive evidence of greater private practice growth in more rural locations. The sharp supply-side changes that we observe indicate that expanding public insurance can have important spillover effects on provider training and practice choices.
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Affiliation(s)
- Alice Chen
- Sol Price School of Public Policy, University of Southern California, Los Angeles, CA, USA
| | - Anthony T Lo Sasso
- School of Public Health, Health Policy and Administration, Institute of Government and Public Affairs, University of Illinois-Chicago, Chicago, IL, USA
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12
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Herwartz H, Schley K. Improving health care service provision by adapting to regional diversity: An efficiency analysis for the case of Germany. Health Policy 2018; 122:293-300. [PMID: 29482949 DOI: 10.1016/j.healthpol.2018.01.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 10/09/2017] [Accepted: 01/03/2018] [Indexed: 11/18/2022]
Abstract
The provision of health care in Germany exhibits sizeable geographic variation with a heterogeneous allocation of medical services in rural and urban areas. Furthermore, distinct utilisation patterns and access barriers due to the socio-economic environment might cause inefficiencies in the provision of health care services. Accordingly, an improved understanding of factors governing inefficiencies in health care provision is likely to benefit an efficient spatial allocation of health care infrastructure. We analyse how socio-economic factors influence the regional distribution of (in)efficiencies in the provision of health care services by means of a stochastic frontier analysis. Our results highlight that regional deprivation relates to inefficient provision of health care services. As a consequence, policies should also consider socio-economic conditions to improve the allocation of medical services and overall health.
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Affiliation(s)
- Helmut Herwartz
- Chair for Econometrics, Georg-August-University Göttingen, Humboldtallee 3, D-37073 Göttingen, Germany.
| | - Katharina Schley
- Chair for Econometrics, Georg-August-University Göttingen, Humboldtallee 3, D-37073 Göttingen, Germany.
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Payments and Utilization of Immunization Services Among Children Enrolled in Fee-for-Service Medicaid. Med Care 2017; 56:54-61. [PMID: 29176369 DOI: 10.1097/mlr.0000000000000844] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine the association between state Medicaid vaccine administration fees and children's receipt of immunization services. METHODS The study used the 2008-2012 Medicaid Analytic eXtract data and included children aged 0-17 years and continuously enrolled in a Medicaid fee-for-service plan in each study year. Analyses were restricted to 8 states with a Medicaid managed-care penetration rate <75%. Linear regressions were used to estimate the probability of children making ≥1 vaccination visit and the numbers of vaccination visits in the year as a function of state Medicaid vaccine administration fees, age group, sex, race/ethnicity, state unemployment rate, state managed-care penetration rate, and state and year-fixed effects. RESULTS A total of 1,678,288 children were included. In 2008-2012, the average proportion of children making ≥1 vaccination visit per year was 31% and the mean number of vaccination visits was 0.9. State Medicaid reimbursements for vaccine administration was positively associated with immunization service utilization; for every $1 increase in the payment amount, the probability of children making ≥1 vaccination visit increased by 0.72 percentage point (95% confidence interval, 0.23-1.21; P=0.01), representing a 2% increase from the mean and the number of vaccination visits increased by 0.03 (95% confidence interval, -0.00 to 0.06; P<0.1). The estimated effect was greater among younger children. CONCLUSION Higher Medicaid reimbursements for vaccine administration were associated with increased proportion of children receiving immunization services.
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Larson K, Cull WL, Racine AD, Olson LM. Trends in Access to Health Care Services for US Children: 2000-2014. Pediatrics 2016; 138:peds.2016-2176. [PMID: 27940710 DOI: 10.1542/peds.2016-2176] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/14/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Recent years have witnessed substantial gains in health insurance coverage for children, but few studies have examined trends across a diverse set of access indicators. We examine US children's access to health services and whether trends vary by race/ethnicity and income. METHODS Analysis of 178 038 children ages 0 to 17 from the 2000 to 2014 National Health Interview Survey. Trends are examined for health insurance and 5 access indicators: no well-child visit in the year, no doctor office visit, no dental visit, no usual source of care, and unmet health needs. Logistic regression models add controls for sociodemographics and child health status. Statistical interactions test whether trends vary by race/ethnicity and income. RESULTS Among all children, uninsured rates declined from 12.1% in 2000 to 5.3% in 2014, with improvement across all 5 access indicators. Along with steep declines in the uninsured rate, Hispanic children had sizeable improvement for no doctor office (19.8% to 11.9%), no dental visit (43.2% to 21.8%), and no usual source of care (13.9% to 6.3%). Black children and those in poor and near-poor families also had large gains. Results from adjusted statistical interaction models showed more improvement for black and Hispanic children versus whites for 3 of 5 access indicators and for children in poor and near-poor families for 4 of 5 access indicators. CONCLUSIONS Children's access to health services has improved since 2000 with greater gains in vulnerable population groups. Findings support a need for continued support of health insurance for all children.
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Affiliation(s)
| | | | - Andrew D Racine
- Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
| | - Lynn M Olson
- Department of Research, American Academy of Pediatrics, Elk Grove Village, Illinois; and
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15
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Davidoff A, Dubay L, Kenney G, Yemane A. The Effect of Parents' Insurance Coverage on Access to Care for Low-Income Children. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2016; 40:254-68. [PMID: 14680258 DOI: 10.5034/inquiryjrnl_40.3.254] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This study examines the effects of having an uninsured parent on access to health care for low-income children. Using data from the 1999 National Survey of America's Families, we find that having an uninsured parent decreases the likelihood that a child will have any medical provider visit by 6.5 percentage points, and decreases the likelihood of a well-child visit by 6.7 percentage points. Estimates for low-income children who have insurance but have an uninsured parent indicate a 4.1 percentage-point reduction in the probability of having any medical provider visit, and a similar 4.2 percentage-point reduction in the probability of having a well-child visit relative to those with insured parents. The effects of having an uninsured parent are smaller in magnitude than the effects of a child being uninsured. Efforts to increase insurance coverage of parents, either by extending eligibility for public insurance or through other policy interventions, will have positive spillover effects on access to care for children. Although the magnitude of these effects is small relative to the direct effect of providing insurance to either the child or parent, they should be considered in analyses of costs and benefits of proposed policies.
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Kenney G, Hadley J, Blavin F. Effects of Public Premiums on Children's Health Insurance Coverage: Evidence from 1999 to 2003. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2016; 43:345-61. [PMID: 17354370 DOI: 10.5034/inquiryjrnl_43.4.345] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This study uses 2000 to 2004 Current Population Survey data to examine the effects of public premiums on the insurance coverage of children whose family incomes are between 100% and 300% of the federal poverty level. The analysis employs multinomial logistic models that control for factors other than premium costs. While the magnitude of the estimated effects varies across models, the results consistently indicate that raising public premiums reduces enrollment in public programs, with some children who forgo public coverage having private coverage instead and others being uninsured. The results indicate that public premiums have larger effects when applied to lower-income families.
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Sarvas EW, Huebner CE, Scott JM, Aps JK, Chi DL. Dental utilization for Medicaid-enrolled children with cystic fibrosis. SPECIAL CARE IN DENTISTRY 2016; 36:315-320. [DOI: 10.1111/scd.12193] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Elise W. Sarvas
- Clinical Assistant Professor; Division of Pediatric Dentistry; University of Minnesota; Minnesota
| | - Colleen E. Huebner
- Associate Professor; Department of Health Services; University of Washington; Washington
| | - JoAnna M. Scott
- Acting Assistant Professor; Department of Pediatric Dentistry; University of Washington; Washington
| | - Johan K.M. Aps
- Clinical Associate Professor; Department of Oral Medicine; University of Washington; Washington
| | - Donald L. Chi
- Associate Professor; Department of Oral Health Sciences; University of Washington; Washington
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Suryavanshi MS, Yang Y. Clinical and Economic Burden of Mental Disorders Among Children With Chronic Physical Conditions, United States, 2008-2013. Prev Chronic Dis 2016; 13:E71. [PMID: 27236382 PMCID: PMC4885682 DOI: 10.5888/pcd13.150535] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION The prevalence of chronic physical and mental disorders is increasing among children and adolescents in the United States. In this study, we investigated the association between mental health disorders and chronic physical conditions among children, and we assessed whether having mental disorders is associated with increased health care costs for children with chronic physical conditions, using Medical Expenditure Panel Survey data from 2008 through 2013. METHODS Children aged 5 to 17 with at least 1 chronic physical condition were included in the study. Chronic physical conditions and mental disorders were identified using International Classification of Diseases, 9th Revision, Clinical Modification codes. We used logistic regression to assess the relationship between mental disorders and chronic physical conditions, and we used generalized linear models with gamma distribution and log link to estimate direct medical costs. RESULTS Of 42,130 children, 4,640 had at least 1 chronic physical condition. After controlling for sociodemographic and health care access characteristics, we found that children with at least 1 chronic physical condition were 62% more likely to have a mental health disorder than were children without chronic physical conditions (odds ratio = 1.62; 95% confidence interval [CI], 1.37-1.92). Having a mental disorder was a significant predictor of total health care cost (β = 0.64; 95% CI, 0.43-0.85; P < .001). The adjusted annual incremental cost due to mental disorders among children with chronic physical conditions was $2,631 (P < .001). CONCLUSION Having chronic physical conditions in childhood is a significant predictor of mental health disorders and total health care expenditures.
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Affiliation(s)
- Manasi S Suryavanshi
- Department of Pharmacy Administration, The University of Mississippi School of Pharmacy, University, Mississippi
| | - Yi Yang
- Department of Pharmacy Administration and Center for Pharmaceutical Marketing and Management, The University of Mississippi School of Pharmacy, Faser Hall, Room 234, University, MS 38677.
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Berdahl T, Hudson J, Simpson L, McCormick MC. Annual Report on Children's Health Care: Dental and Orthodontic Utilization and Expenditures for Children, 2010-2012. Acad Pediatr 2016; 16:314-26. [PMID: 27154430 DOI: 10.1016/j.acap.2016.02.013] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 02/09/2016] [Accepted: 02/18/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine general dental and orthodontic utilization and expenditures by health insurance status, public health insurance eligibility, and sociodemographic characteristics among children aged 0 to 17 years using data from 2010-2012. METHODS Nationally representative data from the Medical Expenditure Panel Survey (2010-2012) provided data on insurance status, public health insurance eligibility, and visits to dental providers for both general dental care and orthodontic care. RESULTS Overall, 41.9% of US children reported an annual dental office-based visit for general (nonorthodontic) dental care. Fewer Hispanic (34.7%) and non-Latino black children (34.8%) received dental care compared to non-Hispanic whites (47.3%) and Asians (40.3%). Children living in families with the lowest income were also the least likely to have a visit (32.9%) compared to children in the highest-income families (54.7%). Among children eligible for public coverage, Medicaid-eligible children had the lowest percentage of preventive dental visits (29.2%). Socioeconomic and racial/ethnic disparities in use and expenditures for orthodontic care are much greater than those for general and preventive dental care. Average expenditures for orthodontic care were $1,823, of which 56% ($1,023) was paid out of pocket by families. CONCLUSIONS Our findings provide a baseline assessment for examining trends in the future, especially as coverage patterns for children may change as the Affordable Care Act is implemented and the future of the State Child Health Insurance Program remains uncertain beyond 2017.
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Affiliation(s)
- Terceira Berdahl
- Agency for Healthcare Research and Quality, Department of Health and Human Services, Rockville, Md.
| | - Julie Hudson
- Agency for Healthcare Research and Quality, Department of Health and Human Services, Rockville, Md
| | | | - Marie C McCormick
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Mass
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Chang LV. THE EFFECT OF STATE INSURANCE MANDATES ON INFANT IMMUNIZATION RATES. HEALTH ECONOMICS 2016; 25:372-386. [PMID: 25773053 DOI: 10.1002/hec.3153] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2013] [Revised: 10/31/2014] [Accepted: 12/30/2014] [Indexed: 06/04/2023]
Abstract
While US infant immunization rates have been increasing in the last 20 years, the cost of fully immunizing a child with all recommended vaccines has almost tripled. This is partly not only due to new additions in the list of recommended vaccines but also due to the use of new, safer, but more expensive technologies in vaccine production and distribution. In recent years, many states have mandated that recommended childhood vaccines be covered by private health insurance companies. Currently, there are 33 states with such a mandate. In this paper, I examine whether the introduction of mandates on private insurers affected immunization rates. Using state and time variation, I find that mandates increased the immunization rate for three vaccines--the diphtheria-tetanus-pertussis, polio, and measles-mumps-rubella vaccines--by about 1.8 percentage points. These results may provide a lower bound for the expected effect of the Affordable Care Act, which mandates coverage of childhood vaccines for all private insurers in the USA. I also find evidence that the mandates shifted a significant portion of vaccinations from publicly funded sources to private ones, with a decline in public health clinic visits and an increase in vaccinations at hospitals and doctor's offices.
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Kreider AR, French B, Aysola J, Saloner B, Noonan KG, Rubin DM. Quality of Health Insurance Coverage and Access to Care for Children in Low-Income Families. JAMA Pediatr 2016; 170:43-51. [PMID: 26569497 PMCID: PMC8011294 DOI: 10.1001/jamapediatrics.2015.3028] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE An increasing diversity of children's health coverage options under the US Patient Protection and Affordable Care Act, together with uncertainty regarding reauthorization of the Children's Health Insurance Program (CHIP) beyond 2017, merits renewed attention on the quality of these options for children. OBJECTIVE To compare health care access, quality, and cost outcomes by insurance type (Medicaid, CHIP, private, and uninsured) for children in households with low to moderate incomes. DESIGN, SETTING, AND PARTICIPANTS A repeated cross-sectional analysis was conducted using data from the 2003, 2007, and 2011-2012 US National Surveys of Children's Health, comprising 80,655 children 17 years or younger, weighted to 67 million children nationally, with household incomes between 100% and 300% of the federal poverty level. Multivariable logistic regression models compared caregiver-reported outcomes across insurance types. Analysis was conducted between July 14, 2014, and May 6, 2015. EXPOSURES Insurance type was ascertained using a caregiver-reported measure of insurance status and each household's poverty status (percentage of the federal poverty level). MAIN OUTCOMES AND MEASURES Caregiver-reported outcomes related to access to primary and specialty care, unmet needs, out-of-pocket costs, care coordination, and satisfaction with care. RESULTS Among the 80,655 children, 51,123 (57.3%) had private insurance, 11,853 (13.6%) had Medicaid, 9554 (18.4%) had CHIP, and 8125 (10.8%) were uninsured. In a multivariable logistic regression model (with results reported as adjusted probabilities [95% CIs]), children insured by Medicaid and CHIP were significantly more likely to receive a preventive medical (Medicaid, 88% [86%-89%]; P < .01; CHIP, 88% [87%-89%]; P < .01) and dental (Medicaid, 80% [78%-81%]; P < .01; CHIP, 77% [76%-79%]; P < .01) visits than were privately insured children (medical, 83% [82%-84%]; dental, 73% [72%-74%]). Children with all insurance types experienced challenges in access to specialty care, with caregivers of children insured by CHIP reporting the highest rates of difficulty accessing specialty care (28% [24%-32%]), problems obtaining a referral (23% [18%-29%]), and frustration obtaining health care services (26% [23%-28%]). These challenges were also magnified for privately insured children with special health care needs, whose caregivers reported significantly greater problems accessing specialty care (29% [26%-33%]) and frustration obtaining health care services (36% [32%-41%]) than did caregivers of children insured by Medicaid, and a lower likelihood of insurance always meeting the child's needs (63% [60%-67%]) than children insured by Medicaid or CHIP. Caregivers of privately insured children were also significantly more likely to experience out-of-pocket costs (77% [75%-78%]) than were caregivers of children insured by Medicaid (26% [23%-28%]; P < .01) or CHIP (38% [35%-40%]; P < .01). CONCLUSIONS AND RELEVANCE This examination of caregiver experiences across insurance types revealed important differences that can help guide future policymaking regarding coverage for families with low to moderate incomes.
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Affiliation(s)
- Amanda R. Kreider
- PolicyLab, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Benjamin French
- Department of Biostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia3Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - Jaya Aysola
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia4Division of General Internal Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia5Division of General Pediatrics
| | - Brendan Saloner
- Department of Health Policy and Management, Bloomberg School of Public Health at Johns Hopkins University, Baltimore, Maryland7Department of Mental Health, Bloomberg School of Public Health at Johns Hopkins University, Baltimore, Maryland8Institute for He
| | - Kathleen G. Noonan
- PolicyLab, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania5Division of General Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania9Master of Public Health Program, University of Pennsylvania, Philadelphia
| | - David M. Rubin
- PolicyLab, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania5Division of General Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania10Department of Pediatrics, Perelman School of Medicine at the University of
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Clemans-Cope L, Kenney G, Waidmann T, Huntress M, Anderson N. How Well Is CHIP Addressing Health Care Access and Affordability for Children? Acad Pediatr 2015; 15:S71-7. [PMID: 25824897 DOI: 10.1016/j.acap.2015.02.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Revised: 02/16/2015] [Accepted: 02/17/2015] [Indexed: 11/15/2022]
Abstract
OBJECTIVE We examine how access to care and care experiences under the Children's Health Insurance Program (CHIP) compared to private coverage and being uninsured in 10 states. METHODS We report on findings from a 2012 survey of CHIP enrollees in 10 states. We examined a range of health care access and use measures among CHIP enrollees. Comparisons of the experiences of established CHIP enrollees to the experiences of uninsured and privately insured children were used to estimate differences in children's health care. RESULTS Children with CHIP coverage had substantially better access to care across a range of outcomes, other things being equal, particularly compared to those with no coverage. Compared to being uninsured, CHIP enrollees were more likely to have specialty and mental health visits and to receive prescription drugs; and their parents were much more likely to feel confident in meeting the child's health care needs and were less likely to have trouble finding providers. CHIP enrollees were less likely to have unmet needs, but 1 in 4 had at least 1 unmet need. Compared to being privately insured, CHIP enrollees had generally similar health care use and unmet needs. Additionally, CHIP enrollees had lower financial burden related to their health care needs. The findings were generally robust with respect to alternative specifications and subgroup analyses, and they corroborated findings of previous studies. CONCLUSIONS Enrolling more of the uninsured children who are eligible for CHIP improved their access to a range of care, including specialty and mental health services, and reduced the financial burden of meeting their health care needs; however, we found room for improvement in CHIP enrollees' access to care.
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McMorrow S, Kenney GM, Anderson N, Clemans-Cope L, Dubay L, Long SK, Wissoker D. Trade-Offs Between Public And Private Coverage For Low-Income Children Have Implications For Future Policy Debates. Health Aff (Millwood) 2014; 33:1367-74. [DOI: 10.1377/hlthaff.2014.0264] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Stacey McMorrow
- Stacey McMorrow ( ) is a senior research associate in the Health Policy Center, Urban Institute, in Washington, D.C
| | - Genevieve M. Kenney
- Genevieve M. Kenney is codirector of and a senior fellow in the Health Policy Center, Urban Institute
| | - Nathaniel Anderson
- Nathaniel Anderson is a research assistant in the Health Policy Center, Urban Institute
| | - Lisa Clemans-Cope
- Lisa Clemans-Cope is a senior research associate in the Health Policy Center, Urban Institute
| | - Lisa Dubay
- Lisa Dubay is a senior fellow in the Health Policy Center, Urban Institute
| | - Sharon K. Long
- Sharon K. Long is a senior fellow in the Health Policy Center, Urban Institute
| | - Douglas Wissoker
- Douglas Wissoker is a senior fellow in the Statistical Methods Group at the Urban Institute
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Abdus S, Selden TM. Adherence with recommended well-child visits has grown, but large gaps persist among various socioeconomic groups. Health Aff (Millwood) 2014; 32:508-15. [PMID: 23459729 DOI: 10.1377/hlthaff.2012.0691] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A goal of federal policy is to improve preventive health care for children. However, little is known about how adherence to recommendations by the American Academy of Pediatrics for well-child visits has changed over time. Using the 1996-2008 Medical Expenditure Panel Surveys, we examined trends in adherence and whether differences across population subgroups narrowed or widened over time. We found that the ratio of actual to recommended well-child visits rose from 46.3 percent during the 1996-98 time period to 58.9 percent during the 2007-08 time period. Although this increase in adherence is important, improvement occurred unevenly. We observed large differences in adherence at the start of the study period across income, race or ethnicity, parent education, region, insurance coverage, and having a usual source of care. None of these differences had narrowed significantly by the end of the study period. Indeed, differences widened across parent education, between those with and without insurance coverage, by usual source of care, and between the Northeast and the Midwest and West regions. Our results highlight the importance of provisions in the Affordable Care Act to expand coverage, strengthen incentives for preventive services, and improve the measurement of preventive services.
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Affiliation(s)
- Salam Abdus
- Social and Scientific Systems, Silver Spring, Maryland, USA
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Zur J, Mojtabai R. Medicaid expansion initiative in Massachusetts: enrollment among substance-abusing homeless adults. Am J Public Health 2013; 103:2007-13. [PMID: 24028262 DOI: 10.2105/ajph.2013.301283] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We assessed whether homeless adults entering substance abuse treatment in Massachusetts were less likely than others to enroll in Medicaid after implementation of the MassHealth Medicaid expansion program in 1997. METHODS We used interrupted time-series analysis in data on substance abuse treatment admissions from the Treatment 0Episode Data Set (1992-2009) to evaluate Medicaid coverage rates in Massachusetts and to identify whether trends differed between homeless and housed participants. We also compared Massachusetts data with data from 17 other states and the District of Columbia combined. RESULTS The percentage of both homeless and housed people entering treatment with Medicaid increased approximately 21% after expansion (P = .01), with an average increase of 5.4% per year over 12 years (P = .01). The increase in coverage was specific to Massachusetts, providing evidence that the MassHealth policy was the cause of this increase. CONCLUSIONS Findings provide evidence in favor of state participation in the Medicaid expansion in January 2014 under the Affordable Care Act and suggest that hard-to-reach vulnerable groups such as substance-abusing homeless adults are as likely as other population groups to benefit from this policy.
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Affiliation(s)
- Julia Zur
- At the time of the study, Julia Zur and Ramin Mojtabai were with the Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
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Ku L, Sharac J, Bruen B, Thomas M, Norris L. Increased use of dental services by children covered by Medicaid: 2000-2010. MEDICARE & MEDICAID RESEARCH REVIEW 2013; 3:mmrr.003.03.b01. [PMID: 24753975 PMCID: PMC3983734 DOI: 10.5600/mmrr.003.03.b01] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
This report analyzes the use of dental services by children enrolled in Medicaid from federal fiscal years (FFY) 2000 to 2010. The number and percent of children receiving dental services under Medicaid climbed continuously over the decade. In FFY 2000, 6.3 million children ages 1 to 20 were reported to receive some form of dental care (either preventive or treatment); the number more than doubled to 15.4 million by FFY 2010. Part of the increase was because the overall number of children covered by Medicaid rose by 12 million (50%), but the percentage of children who received dental care climbed appreciably from 29.3% in FFY 2000 to 46.4% in FFY 2010. In that same time period, the number of children ages 1 to 20 receiving preventive dental services climbed from a reported 5.0 million to 13.6 million, while the percentage of children receiving preventive dental services rose from 23.2% to 40.8%. For children ages 1 to 20 who received dental treatment services, the reported number rose from 3.3 million in FFY 2000 to 7.6 million in FFY 2010. The percentage of children who obtained dental treatment services increased from 15.3% to 22.9%. In FFY 2010, about one sixth of children covered by Medicaid (15.7%) ages 6-14 had a dental sealant placed on a permanent molar. While most states have made steady progress in improving children's access to dental care in Medicaid over the past decade, there is still substantial variation across states and more remains to be done.
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Affiliation(s)
- Leighton Ku
- The George Washington University-Department of Health Policy
| | - Jessica Sharac
- The George Washington University-Department of Health Policy
| | - Brian Bruen
- The George Washington University-Department of Health Policy
| | - Megan Thomas
- Centers for Medicare & Medicaid Services-Center for Medicaid and CHIP Services
| | - Laurie Norris
- Centers for Medicare & Medicaid Services-Center for Medicaid and CHIP Services
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Chi DL, Leroux B. County-level determinants of dental utilization for Medicaid-enrolled children with chronic conditions: how does place affect use? Health Place 2012; 18:1422-9. [PMID: 22981229 DOI: 10.1016/j.healthplace.2012.07.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2012] [Revised: 07/11/2012] [Accepted: 07/26/2012] [Indexed: 10/28/2022]
Abstract
Little is known about how place affects childrens' access to dental care. We analyzed data for 25,908 Iowa Medicaid-enrolled children with chronic conditions to identify the county-level determinants of dental utilization. Our analyses suggest that higher levels of poverty and designation as a dental health professional shortage area at the county-level are associated with lower probability of child-level dental use. There are significant interactions between child-level race/ethnicity and county-level poverty as well as between child-level disability and county-level unemployment. We present a new descriptive model on dental utilization that emphasizes county-level factors as well as interactions between county-level and child-level factors.
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Affiliation(s)
- Donald L Chi
- Department of Oral Health Sciences, University of Washington, Box 357475, Seattle, WA 98195, USA.
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Chi DL, Raklios NA. The relationship between body system-based chronic conditions and dental utilization for Medicaid-enrolled children: a retrospective cohort study. BMC Oral Health 2012; 12:28. [PMID: 22870882 PMCID: PMC3433353 DOI: 10.1186/1472-6831-12-28] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2011] [Accepted: 07/11/2012] [Indexed: 12/14/2022] Open
Abstract
Background Dental care is the most common unmet health care need for children with chronic conditions. However, anecdotal evidence suggests that not all children with chronic conditions encounter difficulties accessing dental care. The goals of this study are to evaluate dental care use for Medicaid-enrolled children with chronic conditions and to identify the subgroups of children with chronic conditions that are the least likely to use dental care services. Methods This study focused on children with chronic conditions ages 3-14 enrolled in the Iowa Medicaid Program in 2005 and 2006. The independent variables were whether a child had each of the following 10 body system-based chronic conditions (no/yes): hematologic; cardiovascular; craniofacial; diabetes; endocrine; digestive; ear/nose/throat; respiratory; catastrophic neurological; or musculoskeletal. The primary outcome measure was use of any dental care in 2006. Secondary outcomes, also measured in 2006, were use of diagnostic dental care, preventive dental care, routine restorative dental care, and complex restorative dental care. We used Poisson regression models to estimate the relative risk (RR) associated with each of the five outcome measures across the 10 chronic conditions. Results Across the 10 chronic condition subgroups, unadjusted dental utilization rates ranged from 44.3% (children with catastrophic neurological conditions) to 60.2% (children with musculoskeletal conditions). After adjusting for model covariates, children with catastrophic neurological conditions were significantly less likely to use most types of dental care (RR: 0.48 to 0.73). When there were differences, children with endocrine or craniofacial conditions were less likely to use dental care whereas children with hematologic or digestive conditions were more likely to use dental care. Children with respiratory, musculoskeletal, or ear/nose/throat conditions were more likely to use most types of dental care compared to other children with chronic conditions but without these specific conditions (RR: 1.03 to 1.13; 1.0 to 1.08; 1.02 to 1.12; respectively). There was no difference in use across all types of dental care for children with diabetes or cardiovascular conditions compared to other children with chronic conditions who did not have these particular conditions. Conclusions Dental utilization is not homogeneous across chronic condition subgroups. Nearly 42% of children in our study did not use any dental care in 2006. These findings support the development of multilevel clinical interventions that target subgroups of Medicaid-enrolled children with chronic conditions that are most likely to have problems accessing dental care.
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Affiliation(s)
- Donald L Chi
- Department of Oral Health Sciences, University of Washington School of Dentistry, Seattle, WA 98195-7475, USA.
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DeVoe JE, Tillotson CJ, Wallace LS, Angier H, Carlson MJ, Gold R. Parent and child usual source of care and children's receipt of health care services. Ann Fam Med 2011; 9:504-13. [PMID: 22084261 PMCID: PMC3252195 DOI: 10.1370/afm.1300] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE In the United States, children who have a usual source of care (USC) have better access to health care than those who do not, but little is known about how parental USC affects children's access. We examined the association between child and parent USC patterns and children's access to health care services. METHODS We undertook a secondary analysis of nationally representative, cross-sectional data from children participating in the 2002-2007 Medical Expenditure Panel Survey (n = 56,302). We assessed 10 outcome measures: insurance coverage gaps, no doctor visits in the past year, less than yearly dental visits, unmet medical and prescription needs, delayed care, problems getting care, and unmet preventive counseling needs regarding healthy eating, regular exercise, car safety devices, and bicycle helmets. RESULTS Among children, 78.6% had a USC and at least 1 parent with a USC, whereas 12.4% had a USC but no parent USC. Children with a USC but no parent USC had a higher likelihood of several unmet needs, including an insurance coverage gap (adjusted risk ratio [aRR] 1.33; 95% confidence interval [CI], 1.21-1.47), an unmet medical or prescription need (aRR 1.70; 95% CI 1.09-2.65), and no yearly dental visits (aRR 1.12; 95% CI 1.06-1.18), compared with children with a USC whose parent(s) had a USC. CONCLUSIONS Among children with a USC, having no parent USC was associated with a higher likelihood of reporting unmet needs when compared with children whose parent(s) had a USC. Policy reforms should ensure access to a USC for all family members.
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Affiliation(s)
- Jennifer E DeVoe
- Department of Family Medicine, Oregon Health & Science University, Portland, 97239, USA.
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Chi DL, Momany ET, Neff J, Jones MP, Warren JJ, Slayton RL, Weber-Gasparoni K, Damiano PC. Impact of chronic condition status and severity on the time to first dental visit for newly Medicaid-enrolled children in Iowa. Health Serv Res 2011; 46:572-95. [PMID: 20849559 PMCID: PMC3008760 DOI: 10.1111/j.1475-6773.2010.01172.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To assess the extent to which chronic condition (CC) status and severity affected how soon children had a dental visit after enrolling in Medicaid. Data Source. Enrollment and claims data (2003-2008) for newly Medicaid-enrolled children ages 3-14 in Iowa. STUDY DESIGN 3M Clinical Risk Grouping methods were used to identify CC status (no/yes) and CC severity (less severe/more severe). Survival analysis was used to identify the factors associated with earlier first dental visits after initially enrolling in Medicaid. PRINCIPAL FINDINGS Children with a CC were 17 percent more likely to have earlier first dental visits after enrolling in Medicaid (p < .0001). There was no significant difference by CC severity. Children who lived in a dental health professional shortage area and those who did not utilize primary medical care had significantly later first Medicaid dental visits, whereas these factors failed to reach statistical significance for children with a CC. CONCLUSION While newly Medicaid-enrolled children with a CC were significantly more likely to have earlier first dental visits, we failed to detect a relationship between CC severity and the time to first Medicaid dental visit. The determinants of first Medicaid dental visits were heterogeneous across subgroups of newly Medicaid-enrolled children. Future studies should identify the sociobehavioral factors associated with CCs that are potential barriers to earlier first Medicaid dental visits for newly Medicaid-enrolled children.
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Affiliation(s)
- Donald L Chi
- School of Dentistry, Department of Dental Public Health Sciences, University of Washington, Seattle, WA 98105, USA.
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Leininger LJ, Meurer J. Access to care for children: recent progress, remaining challenges. Pediatr Ann 2011; 40:161-8. [PMID: 21417207 DOI: 10.3928/00904481-20110217-10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Chi DL, Momany ET, Neff J, Jones MP, Warren JJ, Slayton RL, Weber-Gasparoni K, Damiano PC. Impact of chronic condition status and severity on dental utilization for Iowa Medicaid-enrolled children. Med Care 2011; 49:180-92. [PMID: 21150799 PMCID: PMC3095041 DOI: 10.1097/mlr.0b013e3181f81c16] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Although Medicaid-enrolled children with a chronic condition (CC) may be less likely to use dental care because of factors related to their CC, dental utilization for this population is poorly understood. OBJECTIVE To assess the relationship between CC status and CC severity, respectively, on dental utilization for Iowa Medicaid-enrolled children. RESEARCH DESIGN Retrospective cohort study of Iowa Medicaid data (January 1, 2003 to December 31, 2006). SUBJECTS Medicaid-enrolled children aged 3 to 14 (N = 71,115) years. MEASURES The 3M Corporation Clinical Risk Grouping methods were used to assess CC status (no/yes) and CC severity (episodic/life-long/malignancy/complex). The outcome variable was any dental utilization in 2006. Secondary outcomes included use of diagnostic, preventive, routine restorative, or complex restorative dental care. RESULTS After adjusting for model covariates, Iowa Medicaid-enrolled children with a CC were significantly more likely to use each type of dental care except routine restorative care (P = 0.86) than those without a CC, although the differences in the odds were small (4%-6%). Compared with Medicaid-enrolled children with an episodic CC, children with a life-long CC were less likely to use routine restorative care (P < 0.0001), children with a malignancy were more likely to use complex restorative care (P < 0.03), and children with a complex CC were less likely to use each type of dental care except complex restorative care (P = 0.97). CONCLUSIONS There were differences in dental utilization for Iowa Medicaid-enrolled children by CC status and CC severity. Children with complex CCs were the least likely to use dental care. Future research efforts should seek to understand why subgroups of Medicaid-enrolled children with a CC exhibit lower dental utilization.
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Affiliation(s)
- Donald L Chi
- Department of Dental Public Health Sciences, School of Dentistry, The University of Washington, Seattle, WA 98185, USA.
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Clarke TC, Arheart KL, Muennig P, Fleming LE, Caban-Martinez AJ, Dietz N, Lee DJ. Health care access and utilization among children of single working and nonworking mothers in the United States. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2011; 41:11-26. [PMID: 21319718 DOI: 10.2190/hs.41.1.b] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
To examine indicators of health care access and utilization among children of working and nonworking single mothers in the United States, the authors used data on unmarried women participating in the 1997-2008 National Health Interview Survey who financially supported children under 18 years of age (n = 21,842). Stratified by maternal employment, the analyses assessed health care access and utilization for all children. Outcome variables included delayed care, unmet care, lack of prescription medication, no usual place of care, no well-child visit, and no doctor's visit. The analyses reveal that maternal employment status was not associated with health care access and utilization. The strongest predictors of low access/utilization included no health insurance and intermittent health insurance in the previous 12 months, relative to those with continuous private health insurance coverage (odds ratio ranges 3.2-13.5 and 1.3-10.3, respectively). Children with continuous public health insurance compared favorably with those having continuous private health insurance on three of six access/utilization indicators (odds ratio range 0.63-0.85). As these results show, health care access and utilization for the children of single mothers are not optimal. Passage of the U.S. Healthcare Reform Bill (HR 3590) will probably increase the number of children with health insurance and improve these indicators.
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Affiliation(s)
- Tainya C Clarke
- Department of Epidemiology and Public Health, University of Miami, Miller School of Medicine, Miami, FL 33136, USA.
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Guerrero AD, Garro N, Chang JT, Kuo AA. An update on assessing development in the pediatric office: has anything changed after two policy statements? Acad Pediatr 2010; 10:400-4. [PMID: 21075321 DOI: 10.1016/j.acap.2010.08.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2009] [Revised: 08/03/2010] [Accepted: 08/10/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The aim of this study was to examine parental reports of receiving a child developmental assessment (DA), and the child, family, and type of health care setting characteristics and well-child care processes associated with receiving this aspect of preventive developmental care. METHODS The 2007 National Survey of Children's Health was used to study 16 223 children, aged 10 months to 4 years, who received a DA with a structured questionnaire from their primary care provider in the previous 12 months. Data were adjusted for child characteristics, family socioeconomic factors, type of health care setting, and processes of care. RESULTS Few children were assessed for developmental delays by using developmental questionnaires (28%). A greater percentage of parents of children with public insurance reported receiving a developmental questionnaire compared with parents of children who were uninsured or privately insured (32% vs 26% and 25%, respectively; P = .02). The adjusted odds of receiving a developmental questionnaire were higher for children with public insurance than private insurance (odds ratio [OR] 1.35, 95% confidence interval [CI], 1.05-1.73), higher for children whose usual place of care was a clinic or health center than a doctor's office (OR 1.36, 95% CI, 1.07-1.74), and higher for children reporting adequate family-centered care (OR 1.41, 95% CI, 1.14-1.74). CONCLUSIONS Parental receipt of developmental questionnaires is low and varies by type of insurance, type of place for usual source of care, and adequacy of family-centered care. There is room for improvement in the provision of developmental questionnaires and, our results suggest, areas for continuing research to understand variations in DA practices.
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Affiliation(s)
- Alma D Guerrero
- UCLA Center for Healthier Children, Families and Communities, Los Angeles, Calif 90024, USA.
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Yu J, Harman JS, Hall AG, Duncan RP. Impact of Medicaid/ SCHIP disenrollment on health care utilization and expenditures among children: a longitudinal analysis. Med Care Res Rev 2010; 68:56-74. [PMID: 20675347 DOI: 10.1177/1077558710374620] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study examines the impact of disenrolling from Medicaid/State Children's Health Insurance Programs (SCHIP) on health care utilization and expenditures among children using the 1996-2005 Medical Expenditure Panel Survey data. Changes in expenditures and utilization upon Medicaid/SCHIP disenrollment were examined for two disenrollment groups, children who became uninsured and those who transitioned to private insurance; relative to a control group, those continuously enrolled in Medicaid/SCHIP during the study period. In multivariate analysis, a modified two-part model and difference-in-difference analytic approach were used. The dependent variables were changes in total expenditures and changes in utilization (i.e., well-child visits, physician visits, emergency room visits, hospitalizations, and prescription drug use) from pre- to post-disenrollment round. This study found that losing Medicaid/SCHIP coverage is associated with decreased preventive care utilization among children, regardless of the insurance status post-disenrollment. In addition, children who become uninsured following Medicaid/SCHIP disenrollment may also experience reductions in physician visits and prescription drug use.
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Affiliation(s)
- Jingbo Yu
- HealthCore, Inc., Wilmington, DE 19801, USA.
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Chi DL, Momany ET, Kuthy RA, Chalmers JM, Damiano PC. Preventive dental utilization for Medicaid-enrolled children in Iowa identified with intellectual and/or developmental disability. J Public Health Dent 2010; 70:35-44. [PMID: 19694935 DOI: 10.1111/j.1752-7325.2009.00141.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To compare preventive dental utilization for children with intellectual and/or developmental disability (IDD) and those without IDD and to identify factors associated with dental utilization. METHODS We analyzed Iowa Medicaid dental claims submitted during calendar year (CY) 2005 for a cohort of children ages 3-17 who were eligible for Medicaid for at least 11 months in CY 2005 (n = 107,605). A protocol for identifying IDD children was developed by a group of dentists and physicians with clinical experience in treating children with disabilities. Utilization rates were compared for the two groups. Crude and covariate-adjusted odds ratios were estimated using conditional logistic regression modeling. RESULTS A significantly higher proportion of non-IDD children received preventive care than those identified as IDD (48.6 percent versus 46.1 percent; P < 0.001). However, the final model revealed no statistically significant difference between the two groups. Factors such as older age, not residing in a dental Health Professional Shortage Area, interaction with the medical system, and family characteristics increased one's likelihood of receiving preventive dental care. CONCLUSION Although IDD children face additional barriers to receiving dental care and may be at greater risk for dental disease, they utilize preventive dental services at the same rate as non-IDD children. Clinical and policy efforts should focus on ensuring that all Medicaid-enrolled children receive need-appropriate levels of preventive dental care.
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Affiliation(s)
- Donald L Chi
- Department of Pediatric Dentistry, College of Dentistry, Public Policy Center, The University of Iowa, IA 52246, USA.
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38
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Dubay L, Kenney G. The impact of CHIP on children's insurance coverage: an analysis using the National Survey of America's Families. Health Serv Res 2009; 44:2040-59. [PMID: 19780856 PMCID: PMC2796313 DOI: 10.1111/j.1475-6773.2009.01040.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To assess the impact of the Children's Health Insurance Program (CHIP) on the distribution of health insurance coverage for low-income children. DATA SOURCE The primary data for the study were from the 1997, 1999, and 2002 National Survey of America's Families (NSAF), which includes a total sample of 62,497 children across all 3 years, supplemented with data from other data sources. STUDY DESIGN The study uses quasi-experimental designs and tests the sensitivity of the results to using instrumental variable and difference-in-difference approaches. A detailed Medicaid and CHIP eligibility model was developed for this study. Balanced repeated replicate weights were used to account for the complex sample of the NSAF. Descriptive and multivariate analyses were conducted. PRINCIPLE FINDINGS The results varied depending on the approach utilized but indicated that the CHIP program led to significant increases in public coverage (14-20 percentage points); and declines in employer-sponsored coverage (6-7 percentage points) and in uninsurance (7-12 percentage points). The estimated share of CHIP enrollment attributable to crowd-out ranged from 33 to 44 percent. Smaller crowd-out effects were found for Medicaid-eligible children. CONCLUSIONS Implementation of the CHIP program resulted in large increases in public coverage with estimates of crowd-out consistent with initial projections made by the Congressional Budget Office. This paper demonstrates that public health insurance expansions can lead to substantial reductions in uninsurance without causing a large-scale erosion of employer coverage.
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Affiliation(s)
- Lisa Dubay
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health624 N. Broadway Street, Hampton House Room 488, Baltimore, MD 21205
| | - Genevieve Kenney
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health624 N. Broadway Street, Hampton House Room 488, Baltimore, MD 21205
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Abstract
The concept of a medical home appears to be a key driver for enhancing the value of health services as care systems are transitioned to meet the ongoing challenges of improving quality and containing costs. This article provides an overview of the challenges faced in United States health care delivery systems that affect child health, explains how the medical home might address them, describes methods for measuring quality in medical homes, and identifies barriers to implementation of the model.
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Affiliation(s)
- Steven E Wegner
- AccessCare, 3500 Gateway Centre Boulevard, Suite 130, Morrisville, NC 27560-8501, USA.
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40
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Yoo JP, Slack KS, Holl JL. Material hardship and the physical health of school-aged children in low-income households. Am J Public Health 2009; 99:829-36. [PMID: 18703452 PMCID: PMC2667853 DOI: 10.2105/ajph.2007.119776] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2008] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined the relationship between material hardship reported by low-income caregivers and caregivers' assessments of their children's overall health. METHODS We used logistic regression techniques to analyze data from 1073 children aged 5 through 11 years whose caregivers participated in multiple waves of the Illinois Families Study. RESULTS Caregivers' reports of food hardship were strongly associated with their assessments of their children's health. Other sources of self-reported material hardship were also associated with caregivers' assessments of their children's health, but the effects disappeared when we controlled for caregiver physical health status and mental health status. Proximal measures of material hardship better explained low-income children's health than traditional socioeconomic measures. There were no statistically significant cumulative effects of material hardships above and beyond individual hardship effects. CONCLUSIONS Our findings highlight the importance of developing and supporting programs and policies that ensure access to better-quality food, higher quantities of food, and better living conditions for low-income children, as well as health promotion and prevention efforts targeted toward their primary caregivers as ways to reduce health disparities for this population.
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Affiliation(s)
- Joan P Yoo
- School of Social Work, University of North Carolina, 325 Pittsboro St, CB#3550, Chapel Hill, NC 27599-3550, USA.
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41
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Ku L. Medical and Dental Care Utilization and Expenditures Under Medicaid and Private Health Insurance. Med Care Res Rev 2009; 66:456-71. [PMID: 19389727 DOI: 10.1177/1077558709334896] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Data from the 2005 Medical Expenditure Panel Survey were used to conduct a disaggregated comparison of utilization and expenditures under Medicaid and private health insurance for low-income adults and children. After adjustment for health status and other factors, Medicaid adults and children had greater use of prescription drugs than the privately insured, but there were no significant differences in prescription expenditures. Adults on Medicaid had lower utilization of office-based medical and dental care and much lower expenditures than the privately insured. Contrary to stereotypes, there were no significant differences between Medicaid adults and children and the privately insured in emergency, outpatient, or inpatient hospital use, and the former had significantly lower expenditures.
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Affiliation(s)
- Leighton Ku
- School of Public Health and Health Services, George Washington University, Washington, District of Columbia
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42
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Oberlander JB, Lyons B. Beyond Incrementalism? SCHIP and the politics of health reform. Health Aff (Millwood) 2009; 28:w399-410. [PMID: 19293178 DOI: 10.1377/hlthaff.28.3.w399] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
When Congress enacted the State Children's Health Insurance Program (SCHIP) in 1997, it was heralded as a model of bipartisan, incremental health policy. However, despite the program's achievements in the ensuing decade, SCHIP's reauthorization triggered political conflict, and efforts to expand the program stalemated in 2007. The 2008 elections broke that stalemate, and in 2009 the new Congress passed, and President Barack Obama signed, legislation reauthorizing SCHIP. Now that attention is turning to comprehensive health reform, what lessons can reformers learn from SCHIP's political adventures?
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Foy JE, Hahn K. School-based health centers: A four year experience, with a focus on reducing student exclusion rates. OSTEOPATHIC MEDICINE AND PRIMARY CARE 2009; 3:3. [PMID: 19284562 PMCID: PMC2660344 DOI: 10.1186/1750-4732-3-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/05/2008] [Accepted: 03/10/2009] [Indexed: 11/10/2022]
Abstract
We describe a four year collaborative experience with an on-site, community school-based health center that is staffed by the Vallejo City Unified School District and supervised by the pediatric faculty of the Touro University College of Osteopathic Medicine, with particular attention to first grade student exclusion rates.Patient demographics (including payer source), first grade enrollment statistics, and first grade exclusion rates were analyzed using school district enrollment and exclusion data, billing data, and Child Health Disability Program data.An ethnically diverse patient population is described, with the payer source in 99% of patients being the State of California Child Health Disability Program or no insurance source. Ninety-one percent of office visits were for well child care and immunizations. First grade student exclusion rates for failure to meet the state-mandated physical examination requirement fell 74% over the first four years of the school-based health center's operation.In summary, our school-based health center serves a patient population that is primarily uninsured. Reduction in first grade student exclusion rates enhances student education and reduces the loss of attendance-based state matching funds. Additionally, our school-based health center has been well accepted by the local community.
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Affiliation(s)
- James E Foy
- Touro University California, College of Osteopathic Medicine, 1310 Johnson Lane, Vallejo, CA 94592-1130, USA.
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Jeon KS, Yoon SJ, Ahn HS, Shin HW, Yoon YH, Hwang SM, Kyung MH. The Effect of the Cost Exemption Policy for Hospitalized Children under 6 Years Old on the Medical Utilization in Korea. J Prev Med Public Health 2008; 41:295-9. [DOI: 10.3961/jpmph.2008.41.5.295] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Kyeong-Su Jeon
- Graduate School of Public Health, Korea University, Korea
| | - Seok-Jun Yoon
- Graduate School of Public Health, Korea University, Korea
- Department of Preventive Medicine, College of Medicine, Korea University, Korea
| | - Hyeong-Sik Ahn
- Graduate School of Public Health, Korea University, Korea
- Department of Preventive Medicine, College of Medicine, Korea University, Korea
| | | | | | - Se-Min Hwang
- Graduate School of Public Health, Korea University, Korea
- Department of Preventive Medicine, College of Medicine, Korea University, Korea
| | - Min-Ho Kyung
- Graduate School of Public Health, Korea University, Korea
- Department of Preventive Medicine, College of Medicine, Korea University, Korea
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45
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Hoffman C, Paradise J. Health insurance and access to health care in the United States. Ann N Y Acad Sci 2007; 1136:149-60. [PMID: 17954671 DOI: 10.1196/annals.1425.007] [Citation(s) in RCA: 122] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Health insurance, poverty, and health are all interconnected in the United States. This article synthesizes a large and compelling body of health services research, finding a strong association between health insurance coverage and access to primary and preventive care, the treatment of acute and traumatic conditions, and the medical management of chronic illness. Moreover, by improving access to care, health insurance coverage is also fundamentally important to better health care and health outcomes. Research connects being uninsured with adverse health outcomes, including declines in health and function, preventable health problems, severe disease at the time of diagnosis, and premature mortality.
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Affiliation(s)
- Catherine Hoffman
- Kaiser Commission on Medicaid and the Uninsured, Menlo Park, California 94025, USA.
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46
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Kenney G. The impacts of the State Children's Health Insurance Program on children who enroll: findings from ten states. Health Serv Res 2007; 42:1520-43. [PMID: 17610436 PMCID: PMC1955761 DOI: 10.1111/j.1475-6773.2007.00707.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Examine the extent to which enrollment in the State Children's Health Insurance Program (SCHIP) affects access to care and service use in 10 states that account for over 60 percent of all SCHIP enrollees. DATA SOURCES/STUDY SETTING Surveys of 16,700 SCHIP enrollees were conducted in 2002 as part of a congressionally mandated study. Three domains of SCHIP enrollees were included: (1) children who were recently enrolled in SCHIP, (2) those who had been enrolled in SCHIP for 5 months or more, and (3) those who had recently disenrolled from SCHIP. Response rates varied across states and domains but were clustered between 75 and 80 percent. Five different types of indicators were examined: (1) service use; (2) unmet need; (3) parental perceptions about being able to meet their child's health care needs; (4) presence and type of a usual source of care; and (5) provider communication and accessibility. STUDY DESIGN The experiences SCHIP enrollees have while on the program are compared with those a separate sample of children had before enrolling using a separate sample pretest and posttest design, controlling for observable characteristics of the children and their families. DATA COLLECTION/EXTRACTION METHODS The sample was drawn based on a list frame of SCHIP enrollees. The survey was administered in English and Spanish, by Computer-Assisted Telephone Interviewing (CATI). Field follow-up was used to locate families who could not be reached by telephone and these interviews were conducted by cellular telephone. PRINCIPAL FINDINGS SCHIP enrollment was found to improve access to care along a number of different dimensions, other things equal, particularly relative to being uninsured. Established SCHIP enrollees were more likely to receive office visits, preventive health and dental care, and specialty care, more likely to have a usual source for medical and dental care and to report better provider communication and accessibility, and less likely to have unmet needs, financial burdens, and parental worry associated with meeting their child's health care needs. The findings are robust with respect to alternative specifications and hold up for individual states and subgroups. CONCLUSIONS Enrollment in SCHIP appears to be improving children's access to primary health care services, which in turn is causing parents to have greater peace of mind about meeting their children's needs.
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Affiliation(s)
- Genevieve Kenney
- The Urban Institute, 2100 M Street, NW, Washington, DC 20037, USA
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47
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Hudson JL, Selden TM. Children's eligibility and coverage: recent trends and a look ahead. Health Aff (Millwood) 2007; 26:w618-29. [PMID: 17702792 DOI: 10.1377/hlthaff.26.5.w618] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We used data from the 1996-2005 Medical Expenditure Panel Survey to track changes in children's public insurance eligibility and coverage. During the 2001-2005 "postexpansion" period, eligibility was approximately constant, while public enrollment increased rapidly and uninsurance declined. Nevertheless, as of 2005, 62 percent of all uninsured children (5.5 million) continued to be eligible but not enrolled. We present detailed estimates of their characteristics by age, income, race/ethnicity, health status, and nativity/citizenship. We also examine the impact of potential changes in SCHIP income thresholds--both an expansion and a rollback--and estimate the number and characteristics of the children potentially affected.
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Affiliation(s)
- Julie L Hudson
- Center for Financing, Access, and Cost Trends, Agency for Healthcare Research and Quality, Rockville, Maryland, USA.
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Ketsche P, Adams EK, Minyard K, Kellenberg R. The stigma of public programs: does a separate S-CHIP program reduce it? JOURNAL OF POLICY ANALYSIS AND MANAGEMENT : [THE JOURNAL OF THE ASSOCIATION FOR PUBLIC POLICY ANALYSIS AND MANAGEMENT] 2007; 26:775-89. [PMID: 17894031 DOI: 10.1002/pam.20285] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Previous studies suggest access to and satisfaction with care may be different for enrollees in S-CHIP and Medicaid, but it is unclear whether those differences are fully explained by socioeconomic characteristics of the enrollees. We analyze access and satisfaction of three groups of children: Medicaid enrolled, S-CHIP enrolled, and children who are income eligible for Medicaid but carry a card similar to the state's S-CHIP children's card. Both enrollees and providers may believe that these children are enrolled in S-CHIP despite the fact that reimbursement is through the state's Medicaid system. Results indicate that the same network of providers treat, or are perceived by families to treat, the three groups differently. They support the notion that some of the differences in satisfaction between S-CHIP and Medicaid enrollees are related to unmeasured characteristics (for example, income) of the families in the different programs, but that programmatic identity contributes substantially to differential care experience.
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Affiliation(s)
- Patricia Ketsche
- Institute of Health Administration, Robinson College of Busiess, Georgia State University, USA
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49
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Chen AY, Newacheck PW. Insurance coverage and financial burden for families of children with special health care needs. ACTA ACUST UNITED AC 2006; 6:204-9. [PMID: 16843251 PMCID: PMC1557643 DOI: 10.1016/j.ambp.2006.04.009] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2005] [Revised: 03/16/2006] [Accepted: 04/24/2006] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To examine the role of insurance coverage in protecting families of children with special health care needs (CSHCN) from the financial burden associated with care. METHODS Data from the 2001 National Survey of Children with Special Health Care Needs were analyzed. We built 2 multivariate regression models by using "work loss/cut back" and "experiencing financial problems" as the dependent variables, and insurance status as the primary independent variable of interest while adjusting for income, race/ethnicity, functional limitation/severity, and other sociodemographic predictors. RESULTS Approximately 29.9% of CSHCN live in families where their condition led parents to report cutting back on work or stopping work completely. Families of 20.9% of CSHCN reported experiencing financial difficulties due to the child's condition. Insurance coverage significantly reduced the likelihood of financial problems for families at every income level. The proportion of families experiencing financial problems was reduced from 35.7% to 23.0% for the poor and 44.9% to 24.5% for low-income families with continuous insurance coverage (P < .01 for both comparisons). Similarly, the proportion of parents having to cut back or stop work was reduced from 42.8% to 35.9% for the poor (P < .05) and 43.5% to 33.9% for low-income families (P < .01). CONCLUSIONS Continuous health insurance coverage provides protection from financial burden and hardship for families of CSHCN in all income groups. This evidence is supportive of policies designed to promote universal coverage for CSHCN. However, many poor and low-income families continue to experience work loss and financial problems despite insurance coverage. Hence, health insurance should not be viewed as a solution in itself, but instead as one element of a comprehensive strategy to provide financial safety for families with CSHCN.
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Affiliation(s)
- Alex Y Chen
- Department of Pediatrics, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA 90027, USA.
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50
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Selden TM, Hudson JL. Access to care and utilization among children: estimating the effects of public and private coverage. Med Care 2006; 44:I19-26. [PMID: 16625060 DOI: 10.1097/01.mlr.0000208137.46917.3b] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES We examine the relationship between health insurance coverage and children's access to and utilization of medical care. Access measures we study are having a usual source of care (USC) and lacking a USC for financial or insurance reasons. We also examine indicators for ambulatory visits, well-child visits, dental visits, emergency room use, and inpatient hospital stays. METHODS We pool data from the first 7 years of the Medical Expenditure Panel Survey (MEPS), 1996 to 2002. Pooling yields a large sample of children, enabling us to analyze access and utilization using simple descriptive statistics, multivariate analysis, and instrumental variables estimation (IV). IV estimation is of particular interest given the possibility of bias caused by confounding factors (such as child health or parent attitudes) and measurement error in insurance coverage. We also compare estimates from IV linear probability models to estimates from IV probit with residual inclusion. RESULTS As previous studies have found, public and private coverage are both associated with large increases in access and utilization. Simple mean comparisons suggest that private coverage has a larger effect than does public coverage. Differences between public and private coverage are reduced (and often reversed) when we control for other characteristics of children and their families. IV coverage effect estimates from both linear probability and residual inclusion probit models are substantially greater than conventional estimates across a wide range of access and utilization measures. CONCLUSIONS Despite concerns that conventional estimates overstate the impact of coverage on access and use, our results suggest that the reverse may be true. One explanation may be that conventional estimates are biased toward zero due to error in the reporting of insurance coverage. The magnitude of the coverage effects we find highlights the importance of reducing uninsurance among children.
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Affiliation(s)
- Thomas M Selden
- Division of Modeling and Simulation, Center for Financing, Access, and Cost Trends, Agency for Healthcare Research and Quality, Rockville, Maryland 20850, USA.
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