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Abstract
This study examines the rate of employment in US health care in the postpandemic period, through the end of 2022.
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Affiliation(s)
- Thuy Nguyen
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor
| | - Christopher Whaley
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, Rhode Island
| | - Kosali I. Simon
- O’Neill School of Public and Environmental Affairs, Indiana University, Bloomington
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Agniel D, Cantor J, Golan OK, Yu H, Andraka-Christou B, Simon KI, Stein BD, Taylor EA. How are state telehealth policies associated with services offered by substance use disorder treatment facilities? Evidence from 2019 to 2022. Drug Alcohol Depend 2023; 252:110959. [PMID: 37734281 PMCID: PMC10731590 DOI: 10.1016/j.drugalcdep.2023.110959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 08/17/2023] [Accepted: 09/03/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND The COVID-19 pandemic led several states to adopt policies permitting the delivery of substance use disorder treatment (SUDT) by telehealth. We assess the impact of state-level telehealth policies in 2020 that specifically permitted audio or audiovisual forms of telehealth offerings among SUDT facilities. PROCEDURE Cross-sectional analysis of secondary data from between 2019 and 2022. Pre-pandemic, federal law permitted states to allow audiovisual telehealth modes for SUDT to a limited extent. 2020 laws permitted states to allow audio-only modes for the first time and strengthened ability to offer audiovisual modes. We compared national SUDT facility self-reported telehealth offerings in 2020 and beyond to 2019, in states that in 2020 had policies permitting audiovisual and audio only, compared to other states. MAIN FINDINGS Among outpatient SUDT facilities (n = 5227) present in all four years of our data, the proportion offering telehealth increased from 18% (n = 921) in 2019-26% in 2020, 60% in 2021, and 79% in 2022. We estimate an audiovisual and audio only policy in 2020 was associated with an increase in telehealth offering rates in 2022 of +16.5% points (pp) (95% CI [+10.4,+22.6]) compared to the rates in states with no such listed policy. There was little evidence of an influence on telehealth offering in 2020 (-2.9 pp, CI [-9.0,+3.2]) and 2021 (+0.6 pp, CI [-5.5,+6.7]). CONCLUSIONS The enactment of state-level telehealth policies that allow audio and audiovisual modalities may have increased SUDT facilities' likelihood of offering telehealth services two years after enactment.
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Affiliation(s)
| | | | | | - Hao Yu
- Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
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Miles J, Treitler P, Lloyd J, Samples H, Mahone A, Hermida R, Gupta S, Duncan A, Baaklini V, Simon KI, Crystal S. Racial And Ethnic Disparities In Buprenorphine Receipt Among Medicare Beneficiaries, 2015-19. Health Aff (Millwood) 2023; 42:1431-1438. [PMID: 37782874 PMCID: PMC10910625 DOI: 10.1377/hlthaff.2023.00205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
We examined Medicare Part D claims from the period 2015-19 to identify state and national racial and ethnic disparities in buprenorphine receipt among Medicare disability beneficiaries with diagnosed opioid use disorder or opioid overdose. Racial and ethnic disparities in buprenorphine use remained persistently high during the study period, especially for Black beneficiaries, suggesting the need for targeted interventions and policies.
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Affiliation(s)
- Jennifer Miles
- Jennifer Miles , Rutgers University, New Brunswick, New Jersey
| | | | | | | | | | | | - Sumedha Gupta
- Sumedha Gupta, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana
| | | | | | - Kosali I Simon
- Kosali I. Simon, Indiana University, Bloomington, Indiana
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Andraka-Christou B, Simon KI, Bradford WD, Nguyen T. Buprenorphine Treatment For Opioid Use Disorder: Comparison Of Insurance Restrictions, 2017-21. Health Aff (Millwood) 2023; 42:658-664. [PMID: 37126752 PMCID: PMC10275692 DOI: 10.1377/hlthaff.2022.01513] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Buprenorphine is a treatment medication that decreases mortality risks among people with opioid use disorder (OUD). Despite its efficacy, buprenorphine is underused in the US. Insurance restrictions are commonly cited as barriers to buprenorphine prescribing. Using Medicaid, Medicare Advantage, and commercial insurance formulary files, we examined insurance-imposed utilization restrictions for buprenorphine for OUD for each year from 2017 to 2021 by insurance type. Almost all plans covered immediate-release buprenorphine in 2021, with a general trend of decreasing prior authorization requirements and quantity limits since 2017. In contrast, two payers had relatively low coverage of extended-release buprenorphine, with only 46 percent of commercial plans and only 19 percent of Medicare Advantage plans covering this formulation. Even though most Medicaid plans covered extended-release buprenorphine in 2021, 37 percent required prior authorization. Policy makers and researchers concerned with buprenorphine insurance barriers should shift their attention to extended-release buprenorphine. State lawmakers could help address these barriers by mandating that insurers include extended-release buprenorphine on their preferred drug lists.
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Affiliation(s)
| | - Kosali I Simon
- Kosali I. Simon, Indiana University, Bloomington, Indiana
| | | | - Thuy Nguyen
- Thuy Nguyen, University of Michigan, Ann Arbor, Michigan
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Boustani MA, Perkins AJ, Davis-Ajami ML, Simon KI, Chang CH, Solid CA, Monahan PO. CMS Practice Assessment Tool validity for alternative payment models. Am J Manag Care 2023; 29:e58-e63. [PMID: 36811989 DOI: 10.37765/ajmc.2023.89322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
OBJECTIVES To study the predictive validity of the CMS Practice Assessment Tool (PAT) among 632 primary care practices. STUDY DESIGN Retrospective observational study. METHODS The study included primary care physician practices recruited by the Great Lakes Practice Transformation Network (GLPTN), 1 of 29 CMS-awarded networks, and used data from 2015 to 2019. At enrollment, trained quality improvement advisers scored each of the PAT's 27 milestones by its degree of implementation based on interviews with staff, review of documents, direct observation of practice activity, and professional judgment. The GLPTN also tracked each practice's status regarding alternative payment model (APM) enrollment. Exploratory factor analysis (EFA) was used to identify summary scores; mixed-effects logistic regression was used to assess the relationship between derived scores with APM participation. RESULTS EFA revealed that the PAT's 27 milestones could be summed into 1 overall score and 5 secondary scores. By the end of the 4-year project, 38% of practices were enrolled in an APM. A baseline overall score and 3 secondary scores were associated with increased odds of joining an APM (overall score: odds ratio [OR], 1.06; 95% CI, 0.99-1.12; P = .061; data-driven care quality score: OR, 1.11; 95% CI, 1.00-1.22; P = .040; efficient care delivery score: OR, 1.08; 95% CI, 1.03-1.13; P = .003; collaborative engagement score: OR, 0.88; 95% CI, 0.80-0.96; P = .005). CONCLUSIONS These results demonstrate that the PAT has adequate predictive validity for APM participation.
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Affiliation(s)
- Malaz A Boustani
- Indiana University School of Medicine, 1101 W 10th St, Indianapolis, IN 46202.
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Andersen MS, Bento AI, Basu A, Marsicano CR, Simon KI. College openings in the United States increase mobility and COVID-19 incidence. PLoS One 2022; 17:e0272820. [PMID: 36037207 PMCID: PMC9423614 DOI: 10.1371/journal.pone.0272820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 07/11/2022] [Indexed: 12/01/2022] Open
Abstract
School and college reopening-closure policies are considered one of the most promising non-pharmaceutical interventions for mitigating infectious diseases. Nonetheless, the effectiveness of these policies is still debated, largely due to the lack of empirical evidence on behavior during implementation. We examined U.S. college reopenings’ association with changes in human mobility within campuses and in COVID-19 incidence in the counties of the campuses over a twenty-week period around college reopenings in the Fall of 2020. We used an integrative framework, with a difference-in-differences design comparing areas with a college campus, before and after reopening, to areas without a campus and a Bayesian approach to estimate the daily reproductive number (Rt). We found that college reopenings were associated with increased campus mobility, and increased COVID-19 incidence by 4.9 cases per 100,000 (95% confidence interval [CI]: 2.9–6.9), or a 37% increase relative to the pre-period mean. This reflected our estimate of increased transmission locally after reopening. A greater increase in county COVID-19 incidence resulted from campuses that drew students from counties with high COVID-19 incidence in the weeks before reopening (χ2(2) = 8.9, p = 0.012) and those with a greater share of college students, relative to population (χ2(2) = 98.83, p < 0.001). Even by Fall of 2022, large shares of populations remained unvaccinated, increasing the relevance of understanding non-pharmaceutical decisions over an extended period of a pandemic. Our study sheds light on movement and social mixing patterns during the closure-reopening of colleges during a public health threat, and offers strategic instruments for benefit-cost analyses of school reopening/closure policies.
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Affiliation(s)
- Martin S. Andersen
- Department of Economics, University of North Carolina at Greensboro, Greensboro, North Carolina, United States of America
- * E-mail: (MSA); (AIB)
| | - Ana I. Bento
- Department of Epidemiology and Biostatistics, School of Public Health, Indiana University-Bloomington, Bloomington, Indiana, United States of America
- * E-mail: (MSA); (AIB)
| | - Anirban Basu
- The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, Departments of Pharmacy, Health Services, and Economics, University of Washington, Seattle, Washington, United States of America
| | - Christopher R. Marsicano
- The College Crisis Initiative at Davidson College, Davidson College, Davidson, North Carolina, United States of America
- Educational Studies Department, Davidson College, Davidson, North Carolina, United States of America
| | - Kosali I. Simon
- O’Neill School of Public and Environmental Affairs, Indiana University, Bloomington, Indiana, United States of America
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Balio CP, Blackburn J, Yeager VA, Simon KI, Menachemi N. Many States Were Able To Expand Medicaid Without Increasing Administrative Spending. Health Aff (Millwood) 2021; 40:1740-1748. [PMID: 34724415 DOI: 10.1377/hlthaff.2020.01695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
With the passage of the Affordable Care Act, states were given the option to expand their Medicaid programs. Since then, thirty-eight states and Washington, D.C., have done so. Previous work has identified the widespread effects of expansion on enrollment and the financial implications for individuals, hospitals, and the federal government, yet administrative expenditures have not been considered. Using data from all fifty states for the period 2007-17, our study estimated the effects of Medicaid expansion overall, as well as differing effects by the size and nature of the expansions. Using a quasi-experimental approach, we found no overall effect of expansion on administrative spending. However, the size of the expansion may have produced differing effects. States with small expansions experienced some increases in administrative spending, whereas states with large expansions experienced some decreases in administrative spending, including a $77 reduction in per enrollee administrative spending compared with nonexpansion states. As more states consider expanding their Medicaid programs, our findings provide evidence of potential effects.
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Affiliation(s)
- Casey P Balio
- Casey P. Balio is a research assistant professor at the Center for Rural Health Research, Department of Health Services Management and Policy, East Tennessee State University, in Johnson City, Tennessee. She was a doctoral candidate at the Indiana University Richard M. Fairbanks School of Public Health, in Indianapolis, Indiana, at the time this article was written
| | - Justin Blackburn
- Justin Blackburn is an associate professor in the Department of Health Policy and Management, Indiana University Richard M. Fairbanks School of Public Health
| | - Valerie A Yeager
- Valerie A. Yeager is an associate professor in the Department of Health Policy and Management, Indiana University Richard M. Fairbanks School of Public Health
| | - Kosali I Simon
- Kosali I. Simon is the Herman B. Wells Endowed Professor at the Paul H. O'Neill School of Public and Environmental Affairs and associate vice provost for health sciences, Indiana University, in Bloomington, Indiana
| | - Nir Menachemi
- Nir Menachemi is the Fairbanks Endowed Chair, a professor, and head of the Department of Health Policy and Management, Indiana University Richard M. Fairbanks School of Public Health, and a scientist at the Regenstrief Institute, in Indianapolis, Indiana
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Nguyen TD, Gupta S, Andersen MS, Bento AI, Simon KI, Wing C. Impacts of state COVID-19 reopening policy on human mobility and mixing behavior. South Econ J 2021; 88:458-486. [PMID: 34908602 PMCID: PMC8661958 DOI: 10.1002/soej.12538] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 09/07/2021] [Indexed: 05/05/2023]
Abstract
This study quantifies the effect of the 2020 state COVID economic activity reopening policies on daily mobility and mixing behavior, adding to the economic literature on individual responses to public health policy that addresses public contagion risks. We harness cellular device signal data and the timing of reopening plans to provide an assessment of the extent to which human mobility and physical proximity in the United States respond to the reversal of state closure policies. We observe substantial increases in mixing activities, 13.56% at 4 days and 48.65% at 4 weeks, following reopening events. Echoing a theme from the literature on the 2020 closures, mobility outside the home increased on average prior to these state actions. Furthermore, the largest increases in mobility occurred in states that were early adopters of closure measures and hard-hit by the pandemic, suggesting that psychological fatigue is an important barrier to implementation of closure policies extending for prolonged periods of time.
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Affiliation(s)
- Thuy D. Nguyen
- School of Public HealthUniversity of MichiganAnn ArborMichiganUSA
| | - Sumedha Gupta
- Economics DepartmentIndiana University–Purdue University Indianapolis (IUPUI)IndianapolisIndianaUSA
| | - Martin S. Andersen
- Economics DepartmentUniversity of North Carolina at GreensboroGreensboroNorth CarolinaUSA
| | - Ana I. Bento
- School of Public HealthIndiana UniversityBloomingtonIndianaUSA
| | - Kosali I. Simon
- O'Neill School of Public and Environmental AffairsIndiana UniversityBloomingtonIndianaUSA
- National Bureau of Economic ResearchCambridgeMassachusettsUSA
| | - Coady Wing
- O'Neill School of Public and Environmental AffairsIndiana UniversityBloomingtonIndianaUSA
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Nguyen TD, Gupta S, Andersen MS, Bento AI, Simon KI, Wing C. Impacts of state COVID-19 reopening policy on human mobility and mixing behavior. South Econ J 2021; 88:458-486. [PMID: 34908602 DOI: 10.3386/w27235] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 09/07/2021] [Indexed: 05/26/2023]
Abstract
This study quantifies the effect of the 2020 state COVID economic activity reopening policies on daily mobility and mixing behavior, adding to the economic literature on individual responses to public health policy that addresses public contagion risks. We harness cellular device signal data and the timing of reopening plans to provide an assessment of the extent to which human mobility and physical proximity in the United States respond to the reversal of state closure policies. We observe substantial increases in mixing activities, 13.56% at 4 days and 48.65% at 4 weeks, following reopening events. Echoing a theme from the literature on the 2020 closures, mobility outside the home increased on average prior to these state actions. Furthermore, the largest increases in mobility occurred in states that were early adopters of closure measures and hard-hit by the pandemic, suggesting that psychological fatigue is an important barrier to implementation of closure policies extending for prolonged periods of time.
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Affiliation(s)
- Thuy D Nguyen
- School of Public Health University of Michigan Ann Arbor Michigan USA
| | - Sumedha Gupta
- Economics Department Indiana University-Purdue University Indianapolis (IUPUI) Indianapolis Indiana USA
| | - Martin S Andersen
- Economics Department University of North Carolina at Greensboro Greensboro North Carolina USA
| | - Ana I Bento
- School of Public Health Indiana University Bloomington Indiana USA
| | - Kosali I Simon
- O'Neill School of Public and Environmental Affairs Indiana University Bloomington Indiana USA
- National Bureau of Economic Research Cambridge Massachusetts USA
| | - Coady Wing
- O'Neill School of Public and Environmental Affairs Indiana University Bloomington Indiana USA
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Gupta S, Cantor J, Simon KI, Bento AI, Wing C, Whaley CM. Vaccinations Against COVID-19 May Have Averted Up To 140,000 Deaths In The United States. Health Aff (Millwood) 2021; 40:1465-1472. [PMID: 34406840 PMCID: PMC9937640 DOI: 10.1377/hlthaff.2021.00619] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
COVID-19 vaccination campaigns continue in the United States, with the expectation that vaccines will slow transmission of the virus, save lives, and enable a return to normal life in due course. However, the extent to which faster vaccine administration has affected COVID-19-related deaths is unknown. We assessed the association between US state-level vaccination rates and COVID-19 deaths during the first five months of vaccine availability. We estimated that by May 9, 2021, the US vaccination campaign was associated with a reduction of 139,393 COVID-19 deaths. The association varied in different states. In New York, for example, vaccinations led to an estimated 11.7 fewer COVID-19 deaths per 10,000, whereas Hawaii observed the smallest reduction, with an estimated 1.1 fewer deaths per 10,000. Overall, our analysis suggests that the early COVID-19 vaccination campaign was associated with reductions in COVID-19 deaths. As of May 9, 2021, reductions in COVID-19 deaths associated with vaccines had translated to value of statistical life benefit ranging between $625 billion and $1.4 trillion.
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Affiliation(s)
- Sumedha Gupta
- Department of Economics, Indiana University–Purdue University Indianapolis, in Indianapolis, Indiana
| | - Jonathan Cantor
- Department of Economics, Sociology, and Statistics, RAND Corporation, in Santa Monica, California
| | - Kosali I. Simon
- Paul H. O’Neill School of Public and Environmental Affairs and associate vice provost for health sciences, Indiana University, in Bloomington, Indiana
| | - Ana I. Bento
- Department of Epidemiology and Biostatistics at the School of Public Health, Indiana University
| | - Coady Wing
- Paul H. O’Neill School of Public and Environmental Affairs, Indiana University
| | - Christopher M. Whaley
- Department of Economics, Sociology, and Statistics, RAND Corporation, in Santa Monica
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Aalsma MC, Aarons GA, Adams ZW, Alton MD, Boustani M, Dir AL, Embi PJ, Grannis S, Hulvershorn LA, Huntsinger D, Lewis CC, Monahan P, Saldana L, Schwartz K, Simon KI, Terry N, Wiehe SE, Zapolski TC. Alliances to disseminate addiction prevention and treatment (ADAPT): A statewide learning health system to reduce substance use among justice-involved youth in rural communities. J Subst Abuse Treat 2021; 128:108368. [PMID: 33867210 PMCID: PMC8883586 DOI: 10.1016/j.jsat.2021.108368] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 01/27/2021] [Accepted: 03/12/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Youth in the justice system (YJS) are more likely than youth who have never been arrested to have mental health and substance use problems. However, a low percentage of YJS receive SUD services during their justice system involvement. The SUD care cascade can identify potential missed opportunities for treatment for YJS. Steps along the continuum of the cascade include identification of treatment need, referral to services, and treatment engagement. To address gaps in care for YJS, we will (1) implement a learning health system (LHS) to develop, or improve upon, alliances between juvenile justice (JJ) agencies and community mental health centers (CMHC) and (2) present local cascade data during continuous quality improvement cycles within the LHS alliances. METHODS/DESIGN ADAPT is a hybrid Type II effectiveness implementation trial. We will collaborate with JJ and CMHCs in eight Indiana counties. Application of the EPIS (exploration, preparation, implementation, and sustainment) framework will guide the implementation of the LHS alliances. The study team will review local cascade data quarterly with the alliances to identify gaps along the continuum. The study will collect self-report survey measures longitudinally at each site regarding readiness for change, implementation climate, organizational leadership, and program sustainability. The study will use the Stages of Implementation Completion (SIC) tool to assess the process of implementation across interventions. Additionally, the study team will conduct focus groups and qualitative interviews with JJ and CMHC personnel across the intervention period to assess for impact. DISCUSSION Findings have the potential to increase SUD need identification, referral to services, and treatment for YJS.
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Affiliation(s)
- Matthew C. Aalsma
- Department of Pediatrics – Adolescent Behavioral Health Research Program, Indiana University School of Medicine, Indianapolis, IN, United States of America
| | - Gregory A. Aarons
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States of America
| | - Zachary W. Adams
- Department of Psychiatry - Adolescent Behavioral Health Research Program, Indiana University School of Medicine, Indianapolis, IN, United States of America
| | - Madison D. Alton
- Department of Pediatrics – Adolescent Behavioral Health Research Program, Indiana University School of Medicine, Indianapolis, IN, United States of America
| | - Malaz Boustani
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, United States of America
| | - Allyson L. Dir
- Department of Psychiatry - Adolescent Behavioral Health Research Program, Indiana University School of Medicine, Indianapolis, IN, United States of America
| | - Peter J. Embi
- Department of Medicine, Indiana University School of Medicine, and Regenstrief Institute, Indianapolis, IN, United States of America
| | - Shaun Grannis
- Department of Medicine, Indiana University School of Medicine, and Regenstrief Institute, Indianapolis, IN, United States of America
| | - Leslie A. Hulvershorn
- Department of Psychiatry - Adolescent Behavioral Health Research Program, Indiana University School of Medicine, Indianapolis, IN, United States of America
| | | | - Cara C. Lewis
- MacColl Center for Health Care Innovation, Kaiser Permanente Washington Health Research Institute – Seattle, Washington, United States of America
| | - Patrick Monahan
- Department of Biostatistics, Indiana University School of Medicine and School of Public Health, Indianapolis, IN, United States of America
| | - Lisa Saldana
- Oregon Social Learning Center, Eugene, OR, United States of America
| | - Katherine Schwartz
- Department of Pediatrics - Adolescent Behavioral Health Research Program, Indiana University School of Medicine, Indianapolis, IN, United States of America.
| | - Kosali I. Simon
- School of Public and Environmental Affairs, Indiana University Bloomington, Bloomington, IN, United States of America
| | - Nicolas Terry
- McKinney School of Law, Indiana University – Purdue University Indianapolis, Indianapolis, IN, United States of America
| | - Sarah E. Wiehe
- Department of Pediatrics, Division of Children’s Health Services Research, Indiana University School of Medicine, Indianapolis, IN, United States of America
| | - Tamika C.B. Zapolski
- Department of Psychology - Adolescent Behavioral Health Research Program, Indiana University – Purdue University Indianapolis, Indianapolis, IN, United States of America
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Nguyen TD, Gupta S, Ziedan E, Simon KI, Alexander GC, Saloner B, Stein BD. Assessment of Filled Buprenorphine Prescriptions for Opioid Use Disorder During the Coronavirus Disease 2019 Pandemic. JAMA Intern Med 2021; 181:562-565. [PMID: 33346795 PMCID: PMC7754073 DOI: 10.1001/jamainternmed.2020.7497] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
This cohort study examines changes in the number of buprenorphine prescriptions fill by individuals with opioid use disorder before and during the coronavirus disease 2019 pandemic.
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Affiliation(s)
- Thuy D Nguyen
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor
| | - Sumedha Gupta
- Department of Economics, Indiana University-Purdue University Indianapolis
| | - Engy Ziedan
- Department of Economics, Tulane University, New Orleans, Louisiana
| | - Kosali I Simon
- O'Neill School Public and Environmental Affairs, Indiana University Bloomington
| | - G Caleb Alexander
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Brendan Saloner
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Maclean JC, Wen H, Simon KI, Saloner B. Institutions For Mental Diseases Medicaid Waivers: Impact On Payments For Substance Use Treatment Facilities. Health Aff (Millwood) 2021; 40:326-333. [PMID: 33523735 PMCID: PMC10161239 DOI: 10.1377/hlthaff.2020.00404] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The Institutions for Mental Diseases (IMD) exclusion prohibits use of federal Medicaid funds to treat enrollees ages 21-64 in psychiatric residential treatment facilities that have more than sixteen beds. In 2015 the federal government created a streamlined application pathway for state waivers of this rule to allow Medicaid coverage for substance use disorder (SUD) treatment in residential facilities. Nine states received IMD waivers during the period 2015-18. Using data from the 2010-18 National Survey of Substance Abuse Treatment Services, we examined changes in residential and outpatient SUD treatment facilities' acceptance of Medicaid and other types of health coverage, as well as self-pay arrangements and provision of charity care, after states' adoption of IMD waivers. Acceptance of Medicaid increased 34 percent at residential treatment facilities and 9 percent at intensive outpatient facilities two years after waiver implementation. Delivery of medications for opioid use disorder did not increase in residential facilities post waiver but did increase to some extent in outpatient facilities. Our findings suggest that IMD waivers may be an important tool for advancing access to a full continuum of SUD treatment for Medicaid enrollees.
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Affiliation(s)
- Johanna Catherine Maclean
- Johanna Catherine Maclean is an associate professor of economics at Temple University, in Philadelphia, Pennsylvania; a research associate at the National Bureau of Economic Research in Cambridge, Massachusetts; and a research affiliate at the Institute of Labor Economics in Bonn, Germany
| | - Hefei Wen
- Hefei Wen is an assistant professor in the Division of Health Policy and Insurance Research, Department of Population Medicine, Harvard Medical School and the Harvard Pilgrim Health Care Institute, in Boston, Massachusetts
| | - Kosali I Simon
- Kosali I. Simon is the Herman B. Wells Endowed Professor at the Paul H. O'Neill School of Public and Environmental Affairs and associate vice provost for health sciences, Indiana University, in Bloomington, Indiana
| | - Brendan Saloner
- Brendan Saloner is the Bloomberg Associate Professor of American Health in the Department of Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health, in Baltimore, Maryland
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Abstract
This article aimed to determine the association between the Affordable Care Act young adult mandate and suicidal behavior. From 2007 to 2013, we used the Nationwide/National Inpatient Sample and National Poison Data System to examine suicide attempt, and Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research to examine suicide. We aggregated each outcome by quarter/year and conducted a difference-in-differences linear regression to compare young adults aged 19 to 25 years with those 27 to 29 years before and after implementation. There were not statistically significant associations between the mandate and suicide attempt inpatient hospitalizations (unstandardized beta coefficient [b] = -0.72, p = .12, standard error [SE] = 0.42) and percentage of poisoning cases due to suspected suicidal intent (b = 0.23, p = .19, SE = 0.16). There was a statistically significant association when examining suicide prevalence (b = -0.03, p = .01, SE = 0.001). The results suggest that health insurance may buffer against but is unlikely to reverse the increasing suicide rate.
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Affiliation(s)
| | - Blake A Froberg
- Indiana University School of Medicine, Indianapolis, IN, USA
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15
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Affiliation(s)
- Aparna Soni
- Aparna Soni is an assistant professor of public administration and policy in the School of Public Affairs, American University, in Washington, D.C
| | - Laura R. Wherry
- Laura R. Wherry is an assistant professor of medicine in the David Geffen School of Medicine, University of California Los Angeles
| | - Kosali I. Simon
- Kosali I. Simon is the Herman B Wells Endowed Professor at the O’Neill School of Public and Environmental Affairs, and associate vice provost for health sciences, Indiana University, in Bloomington
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Nguyen TD, Bradford WD, Simon KI. Pharmaceutical payments to physicians may increase prescribing for opioids. Addiction 2019; 114:1051-1059. [PMID: 30667135 DOI: 10.1111/add.14509] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 09/24/2018] [Accepted: 11/21/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIMS Given the recent complete suspension of opioid-related promotional activities aimed at physicians, interest has renewed in understanding the role of promotion in the US opioid crisis. The present analysis aimed to measure associations between such interactions and opioid prescribing. DESIGN Data on all promotions by pharmaceutical companies directly to physicians were linked to physician-level data on opioid prescriptions filled in a federal insurance program and analyzed using multivariate regression. SETTING United States. PARTICIPANTS A total of 865 347 US physicians, with prescriptions filled in Medicare Part D, that might receive payments from pharmaceutical promotional activities from 2014 to 2016. MEASUREMENTS The outcome variable was days' supply dispensed by each prescriber, by year, for all opioids (collectively) and separately for the following opioid classes: hydrocodone, oxycodone, fentanyl, tapentadol, morphine and a catch-all 'other opioids'. The independent variables were receipt of any payments and dollar amounts of payments received by each prescriber by year for all opioids and separately for opioid categories. FINDINGS Prescribers who received opioid-specific payments prescribed 8784 opioid daily doses per year more than their peers who did not receive any such payments (P < 0.001). Recipient of hydrocodone-related payments was associated with 5161 additional daily doses of hydrocodone (P < 0.001). Recipient of oxycodone-related payments was associated with 3624 additional daily doses of oxycodone (P < 0.001). Prescribers receiving any fentanyl-specific payments prescribed 1124 daily doses per year more than their peers (P < 0.001). Among recipients of opioid-specific payments (63 062 physicians), a 1% increase in amount of payments was associated with 50 daily doses of opioid prescription (P < 0.001). CONCLUSIONS In the United States, physicians who receive direct payments from providers for opioid prescribing tend to prescribe substantially larger quantities, particularly for hydrocodone and oxycodone.
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Affiliation(s)
- Thuy D Nguyen
- School of Public and Environmental Affairs, Indiana University, Bloomington, IN, USA
| | - W David Bradford
- Department of Public Administration and Policy, University of Georgia, Athens, GA, USA
| | - Kosali I Simon
- School of Public and Environmental Affairs, Indiana University, Bloomington, IN, USA.,National Bureau of Economic Research, Cambridge, MA, USA
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17
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Abstract
In 2015, Indiana expanded eligibility for Medicaid under the Affordable Care Act (ACA) through a unique waiver, Healthy Indiana Plan 2.0, which requires enrollees to make monthly contributions to an account that is similar to a health savings account to receive full benefits. Enrollees who fail to make these contributions receive less generous benefits if their income is below the federal poverty level, and if it is 100-138 percent of poverty, they are locked out of coverage for six months. We estimated the impact of this expansion on coverage rates and compared the effects to results from other states that expanded Medicaid after 2014. We found that Indiana's coverage gains (relative to pre-ACA uninsurance rates) were smaller than gains in neighboring expansion states, but larger than those in other states. These results imply that while one potential reason for Indiana's lower gains relative to neighboring states was its cost-sharing requirements, expansion led to unquestionable coverage gains in the state.
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Affiliation(s)
- Seth Freedman
- Seth Freedman ( ) is an assistant professor in the School of Public and Environmental Affairs, Indiana University, in Bloomington
| | - Lilliard Richardson
- Lilliard Richardson is a professor in the School of Public and Environmental Affairs, Indiana University-Purdue University Indianapolis
| | - Kosali I Simon
- Kosali I. Simon is a professor in the School of Public and Environmental Affairs, Indiana University
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Soni A, Burns ME, Dague L, Simon KI. Medicaid Expansion And State Trends In Supplemental Security Income Program Participation. Health Aff (Millwood) 2017; 36:1485-1488. [DOI: 10.1377/hlthaff.2016.1632] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Aparna Soni
- Aparna Soni is a PhD candidate in the Department of Business Economics and Public Policy, Indiana University, in Bloomington
| | - Marguerite E. Burns
- Marguerite E. Burns is an assistant professor in the Department of Population Health Sciences at the University of Wisconsin–Madison
| | - Laura Dague
- Laura Dague is an assistant professor in the Bush School of Government and Public Service at Texas A&M University, in College Station
| | - Kosali I. Simon
- Kosali I. Simon is a professor in the School of Public and Environmental Affairs at Indiana University and a research associate of the National Bureau of Economic Research, in Cambridge, Massachusetts
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Gurley-Calvez T, Kenney GM, Simon KI, Wissoker D. Impacts on Emergency Department Visits from Personal Responsibility Provisions: Evidence from West Virginia's Medicaid Redesign. Health Serv Res 2016; 51:1424-43. [PMID: 26762205 DOI: 10.1111/1475-6773.12434] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVE To examine the impact of a 2007 redesign of West Virginia's Medicaid program, which included an incentive and "nudging" scheme intended to encourage better health care behaviors and reduce Emergency Department (ED) visits. DATA SOURCES West Virginia Medicaid enrollment and claims data from 2005 to 2010. STUDY DESIGN We utilized a "differences in differences" technique with individual and time fixed effects to assess the impact of redesign on ED visits. Starting in 2007, categorically eligible Medicaid beneficiaries were moved from traditional Medicaid to the new Mountain Health Choices (MHC) Program on a rolling basis, approximating a natural experiment. Members chose between a Basic plan, which was less generous than traditional Medicaid, or an Enhanced plan, which was more generous but required additional enrollment steps. DATA COLLECTION Data were obtained from the West Virginia Bureau for Medical Services. PRINCIPAL FINDINGS We found that contrary to intentions, the MHC program increased ED visits. Those who selected or defaulted into the Basic plan experienced increased overall and preventable ED visits, while those who selected the Enhanced plan experienced a slight reduction in preventable ED visits; the net effect was an increase in ED visits, as most individuals enrolled in the Basic plan.
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Affiliation(s)
- Tami Gurley-Calvez
- Health Policy and Management, University of Kansas Medical Center, Kansas City, KS
| | | | - Kosali I Simon
- School of Public and Environmental Affairs and National Bureau of Economic Research, Indiana University, Bloomington, IN
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20
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Affiliation(s)
- Asako S. Moriya
- Asako S. Moriya ( ) is a service fellow economist in the Center for Financing, Access and Cost Trends at the Agency for Healthcare Research and Quality (AHRQ), in Rockville, Maryland
| | - Thomas M. Selden
- Thomas M. Selden is a director of the Division of Research and Modeling, Center for Financing, Access and Cost Trends, at AHRQ
| | - Kosali I. Simon
- Kosali I. Simon is a professor in the School of Public and Environmental Affairs at Indiana University, in Bloomington and a research associate at the National Bureau of Economic Research in Cambridge, Massachusetts
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21
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Gooptu A, Moriya AS, Simon KI, Sommers BD. Medicaid Expansion Did Not Result In Significant Employment Changes Or Job Reductions In 2014. Health Aff (Millwood) 2016; 35:111-8. [DOI: 10.1377/hlthaff.2015.0747] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Angshuman Gooptu
- Angshuman Gooptu is a doctoral student in the School of Public and Environmental Affairs at Indiana University, in Bloomington
| | - Asako S. Moriya
- Asako S. Moriya (
) is a service fellow economist in the Center for Financing, Access and Cost Trends at the Agency for Healthcare Research and Quality, in Rockville, Maryland
| | - Kosali I. Simon
- Kosali I. Simon is a professor in the School of Public and Environmental Affairs at Indiana University and a research associate at the National Bureau of Economic Research in Cambridge, Massachusetts
| | - Benjamin D. Sommers
- Benjamin D. Sommers is an assistant professor in the Department of Health Policy and Management at the Harvard T.H. Chan School of Public Health and in the Department of Medicine at Brigham and Women’s Hospital, in Boston, Massachusetts
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22
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Akosa Antwi Y, Moriya AS, Simon KI. Access to health insurance and the use of inpatient medical care: evidence from the Affordable Care Act young adult mandate. J Health Econ 2015; 39:171-87. [PMID: 25544401 DOI: 10.1016/j.jhealeco.2014.11.007] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 06/05/2014] [Accepted: 11/22/2014] [Indexed: 05/22/2023]
Abstract
The Affordable Care Act of 2010 expanded coverage to young adults by allowing them to remain on their parent's private health insurance until they turn 26 years old. While there is evidence on insurance effects, we know very little about use of general or specific forms of medical care. We study the implications of the expansion on inpatient hospitalizations. Given the prevalence of mental health needs for young adults, we also specifically study mental health related inpatient care. We find evidence that compared to those aged 27-29 years, treated young adults aged 19-25 years increased their inpatient visits by 3.5 percent while mental illness visits increased 9.0 percent. The prevalence of uninsurance among hospitalized young adults decreased by 12.5 percent; however, it does not appear that the intensity of inpatient treatment changed despite the change in reimbursement composition of patients.
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Affiliation(s)
- Yaa Akosa Antwi
- Department of Economics, Indiana University-Purdue University Indianapolis (IUPUI), United States.
| | - Asako S Moriya
- The School of Public and Environmental Affairs (SPEA), Indiana University, United States.
| | - Kosali I Simon
- The School of Public and Environmental Affairs (SPEA), Indiana University, United States; National Bureau of Economic Research (NBER), United States.
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23
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Reed AE, Mikels JA, Simon KI. Older adults prefer less choice than young adults. Translational Issues in Psychological Science 2014. [DOI: 10.1037/2332-2136.1.s.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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24
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Borden WB, Willage B, Bishop TF, Mushlin AI, Simon KI. Abstract 254: Impact of Medical Study Publication on Cholesterol Medication Prescriptions. Circ Cardiovasc Qual Outcomes 2013. [DOI: 10.1161/circoutcomes.6.suppl_1.a254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
While research publication is associated with changes in clinical practice to varying degrees, it is unknown what spillover effects may change prescriptions of medications that are similar to, but different from, study medications. In 2008, the ENHANCE trial showed no benefit of simvastatin/ezetimibe over simvastatin alone, calling into question the benefit of ezetimibe. We hypothesize that this new ezetimibe information would have a negative impact by decreasing statin prescriptions.
Methods:
In the Source Healthcare Analytics ProMetis database, we performed a pre/post analysis of prescriptions rates for cholesterol-lowering medicines surrounding the January 14, 2008, release of the ENHANCE study results. We quantified prescription rates of the ENHANCE study medication simvastatin/ezetimibe, as well as ezetimibe alone and other cholesterol-lowering medications by class. This allowed us to assess the direct effect of the trial results on the affected drug, as well as potential spillovers to non-trial similar drugs.
Results:
From December 2007 to September 2008, simvastatin/ezetimibe prescriptions decreased nationally by averages of 70,594, 25,480, and 45,114 per month, for total, new, and refill prescriptions respectively. Ezetimibe total, new, and refill prescriptions decreased nationally by averages of 44,760, 16,141, and 28,618 per month, respectively. Conversely, total, new, and refill prescriptions for statins as a class increased by averages of 151,221, 43,599, and 107,621 per month, respectively. When examining the time immediately after the ENHANCE trial result release, simvastatin/ezetimibe and ezetimibe prescriptions decreased and at a steeper rate. Statin total, new, and refill prescriptions also decreased by 836,608, 208,114, and 628,494 from January to February 2008, respectively (Figure).
Conclusions:
These data suggest that the ENHANCE trial had spillover effects with a transient decrease in statin prescriptions. In light of the deleterious effects of acute statin discontinuation, this finding necessitates further exploration to understand the factors driving these health care decisions, and approaches to disseminating research findings that result in more targeted and appropriate changes in clinical practice.
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25
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Avery RJ, Eisenberg MD, Simon KI. The impact of direct-to-consumer television and magazine advertising on antidepressant use. J Health Econ 2012; 31:705-718. [PMID: 22835472 DOI: 10.1016/j.jhealeco.2012.05.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2011] [Revised: 05/07/2012] [Accepted: 05/08/2012] [Indexed: 05/27/2023]
Abstract
We examine whether exposure to direct-to-consumer advertising (DTCA) for antidepressant drugs affects individual use of these medications among those suffering from depression. Prior studies have almost exclusively relied on making connections between national or market-level advertising volume/expenditures and national or individual-level usage of medications. This is the first study to: estimate the impact of individual-level exposure to DTCA on individual-level use of antidepressants; estimate the impact of individual-level exposure to television DTCA on individual-level use in any drug class; consider the relative and interactive impact of DTCA in two different media in any drug class; and, consider the heterogeneity of impact among different populations in an econometric framework in the antidepressant market. There are also important limitations to note. Unlike prior market level studies that use monthly data, we are limited to aggregated annual data. Our measures of potential advertising exposure are constructed assuming that media consumption patterns are stable during the year. We are also not able to study the impact of advertising on use of antidepressants for conditions other than depression, such as anxiety disorders. We find that: DTCA impacts antidepressant use in a statistically and economically significant manner; that these effects are present in both television and magazine advertising exposure but do not appear to have interactive effects; are stronger for women than for men in the magazine medium, but are about equally strong for men and women in the TV medium; and, are somewhat stronger for groups suffering from more severe forms of depression. The overall size of the effect is a 6-10 percentage point increase in antidepressant use from being exposed to television advertising; the corresponding magazine effects are between 3 and 4 percentage points.
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Affiliation(s)
- Rosemary J Avery
- Department of Policy Analysis and Management, Cornell University, United States
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26
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Abstract
The authors evaluated fair balance in the presentation of risks and benefits in a large sample of direct-to-consumer advertising for prescription antidepressant medications appearing in magazines (1995-2006) and television (1999-2007) to assess how well they meet U.S. Food and Drug Administration guidelines. Using content analysis to capture relevant dimensions of the ads, results indicated that (a) considerably less attention is given to risks relative to benefits and (b) implicit ad content favors communication of drug benefits over risks, but that fair balance in direct-to-consumer ads has improved over time. The authors discuss policy implications and explore future research directions.
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Affiliation(s)
- Rosemary J Avery
- Department of Policy Analysis and Management, Cornell University, Ithaca, New York 14853, USA.
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27
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Abstract
Abstract
Beginning in the mid-1980s and extending through the early to mid-1990s, a substantial number of women and children in the United States gained eligibility for Medicaid through a series of income-based expansions. Using natality data from the National Center for Health Statistics, we estimate fertility responses to these eligibility expansions. We follow Currie and Gruber (2001) and measure changes in state Medicaid-eligibility policy by simulating the fraction of a standard population that would qualify for benefits in different states and different time periods. From 1985 to 1996, the fraction of women aged 15–44 who were eligible for Medicaid coverage for a pregnancy increased more than 20 percentage points. When we use a state and year fixed-effects model with a limited set of covariates, our estimates indicate that fertility increases in response to Medicaid expansions. However, after we include fixed effects for demographic characteristics, the estimated relationship diminishes substantially in size and is no longer statistically significant. We conclude that there is no robust relationship between Medicaid expansions and fertility.
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Affiliation(s)
- Thomas DeLeire
- University of Wisconsin–Madison and NBER, Madison, WI, USA
| | - Leonard M. Lopoo
- Department of Public Administration, The Maxwell School, Syracuse University, 426 Eggers Hall, Syracuse, NY 13244–1020, USA
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28
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Lhila A, Simon KI. Relative deprivation and child health in the USA. Soc Sci Med 2010; 71:777-85. [DOI: 10.1016/j.socscimed.2010.03.058] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2009] [Revised: 01/20/2010] [Accepted: 03/24/2010] [Indexed: 11/29/2022]
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Abstract
Choice is highly valued in modern society, from the supermarket to the hospital; however, it remains unknown whether older and younger adults place the same value on increased choice. The current investigation tested whether 53 older (M age = 75.44 years) versus 53 younger adults (M age = 19.58 years) placed lower value on increased choice by examining the monetary amounts they were willing to pay for increased prescription drug coverage options--important given the recently implemented Medicare prescription drug program. Results indicate that older adults placed lower value on increasing choice sets relative to younger adults, who placed progressively higher value on increasingly larger choice sets. These results are discussed regarding their implications for theory and policy.
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Affiliation(s)
- Joseph A Mikels
- Department of Human Development, Cornell University, G60 Martha Van Rensselaer Hall, Ithaca, NY 14853-4401, USA.
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30
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Ketcham JD, Simon KI. Medicare Part D's effects on elderly patients' drug costs and utilization. Am J Manag Care 2008; 14:SP14-SP22. [PMID: 18991476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To analyze Medicare Part D's net effect on elderly patients' use of and out-of-pocket (OOP) costs for prescription drugs and to compare these with standardized results from prior studies. STUDY DESIGN Our dataset contains 1.4 billion prescriptions from Wolters Kluwer Health from December 2004 through December 2007 for patients whose age as of 2007 was more than 57 years. METHODS Days' supply per capita, OOP cost per day's supply, and number of individuals filling prescriptions were compared before and after January 2006 for those over age 66 years versus those age 58-64 years. Adjustment was made for under-reporting of pure cash prescriptions in the data. RESULTS Elderly patients' utilization in the first year of Part D increased compared with that of near-elderly patients by 8.1% for days' supply and 4.8% for the number of individuals filling prescriptions, and their OOP costs declined by 17.2%. Although elderly patients' OOP costs in the second year were reduced an additional 5.8%, days' supply increased by only an additional 1.0%. Correcting for the under-reporting of pure cash prescriptions yielded effects of 8.1% and -3.5% for days' supply and -15.6% and -7.2% for OOP costs in 2006 and 2007, respectively. A standardized comparison with previous estimates from Walgreens data showed that our utilization estimates were 2.6 times larger. CONCLUSION Part D lowered elderly patients' OOP costs and increased utilization, primarily during the first year of the program. Magnitudes vary substantially across studies because of differences in data and methods.
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Affiliation(s)
- Jonathan D Ketcham
- WP Carey School of Business, School of Health Management and Policy, Arizona State University, 300 E Lemon St, Tempe, AZ 85287-4506, USA.
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31
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Abstract
Previous research has demonstrated that older adults prefer less autonomy and seek less information when making decisions on their own relative to young adults (for a review, see M. Mather, 2006). Would older adults also prefer fewer options from which to choose? The authors tested this hypothesis in the context of different decision domains. Participants completed a choice preferences survey in which they indicated their desired number of choices across 6 domains of health care and everyday decisions. The hypothesis was confirmed across all decision domains. The authors discuss implications from these results as they relate to theories of aging and health care policy.
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Affiliation(s)
- Andrew E Reed
- Department of Human Development, Cornell University, Ithaca, NY 14853, USA.
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Abstract
BACKGROUND Much anecdotal evidence exists regarding the managed care backlash of the late 1990s, but limited empirical evidence is available. OBJECTIVES Using a unique series of employer surveys, we examined trends in enrollment rates in health maintenance organizations (HMOs) and other plan types between 1997 and 2003. RESEARCH DESIGN We present enrollment rates in employer-sponsored health plans by plan type. These plan-level enrollment rates are disaggregated by whether or not enrollees had a choice of plan types and by firm size and year. SUBJECTS Employees who were enrolled in employer-sponsored health insurance in private sector establishments. RESULTS AND CONCLUSIONS Although we found evidence of a decline in the popularity of HMOs, it occurred later than indicated in earlier studies. In our data, HMO enrollment rates fell from roughly 32% to 26% between 1997 and 2003, with most of the decline occurring after 2001. Earlier studies reported that the decline in HMO enrollment rates occurred between 1996 and 1998, and between 2000 and 2001. In addition, an interesting story emerged when we examined trends by firm size. We found evidence of a decline in the HMO enrollment rate for large employers starting in 1998. However, this was offset by an increase in the HMO enrollment rate in small employers, which explains the stability in our figures before 2002. Our data also indicated that when workers were given a choice between an HMO and other plan types, workers increasingly opted for the non-HMO plan during this time period.
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Affiliation(s)
- Philip F Cooper
- Center for Financing, Access and Cost Trends, Agency for Healthcare Research and Quality, Rockville, Maryland, USA
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34
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Affiliation(s)
| | - Kosali I Simon
- Department of Policy Analysis and Management, Cornell University, Ithaca, NY
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Abstract
OBJECTIVE To measure the change in U.S. women and children's health insurance coverage as a result of welfare reform (i.e. the creation of Temporary Assistance for Needy Families or TANF) in 1996. DATA SOURCE 1992-1999 longitudinal data from the Survey of Income and Program Participation (SIPP) merged with data on the timing of state implementation of welfare reform after 1996. Two key advantages of the SIPP data are that they permit matching type of insurance coverage to the welfare policy environment in each state in each month, and permit controlling for individual-level fixed effects. STUDY DESIGN We measure how much insurance coverage changed after welfare reform using a difference in differences method that eliminates the influence of time-invariant unobserved individual heterogeneity and of statewide trends in insurance coverage. Models also control for individual, state, and year fixed effects, individual-level characteristics such as education, age, and number of children, plus state-level variables such as real per capita income, real minimum wage, and Medicaid eligibility. DATA COLLECTION/EXTRACTION METHODS We limit our analysis to the SIPP data specific to the month just completed prior to the interview; as a result, we have up to twelve observations for each individual in the SIPP. This paper uses pooled data from the 1992-1996 panels of the SIPP covering the period 1992-1999. Publicly available state identifiers permit the merger of state policies and macroeconomic variables with the SIPP. PRINCIPAL FINDINGS TANF implementation is associated with an 8.1 percent increase in the probability that a welfare-eligible woman was uninsured. Welfare reform had less of an impact on the health insurance coverage of children. For example, TANF implementation was associated with a 3.0 percent increase in the probability that a welfare-eligible child lacked health insurance. CONCLUSIONS An unintended consequence of welfare reform was to adversely impact the health insurance coverage of economically vulnerable women and children, and that this impact was several times larger than the previous literature implies.
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Affiliation(s)
- John Cawley
- Department of Policy Analysis and Management, Cornell University, Ithaca, NY 14853, USA
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36
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Abstract
This paper investigates the relationship between the macroeconomy and health insurance coverage for non-elderly Americans. We find that, for men, state unemployment rate is positively correlated with the probability of health insurance coverage in general and through an employer in particular, and that these correlations are only partly explained by changes in employment status. In contrast, the insurance coverage of women and children appears to be insulated from fluctuations in the unemployment rate by public health insurance programs like Medicaid and State Children's Health Insurance Program (SCHIP). We estimate that 984,000 Americans, nearly all of whom were adult men, lost health insurance due to macroeconomic conditions alone during the 2001 recession.
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Affiliation(s)
- John Cawley
- Department of Policy Analysis and Management, College of Human Ecology, Cornell University, 134 Martha Van Rensselaer Hall, Ithaca, NY 14853-4401, USA
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37
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Abstract
Job changes that result from plant closings and mass layoffs provide an opportunity to see how workers respond to an employment shock that is arguably exogenous to individual productivity. Comparing compensation packages of displaced workers on their old and new jobs is a potentially promising method to infer a tradeoff between wages and non-wage benefits. Although displaced worker data overcomes many of the pitfalls to estimating wage/fringe tradeoffs by controlling for time-invariant unobserved productivity, time-varying unobservables could still bias estimates. In this analysis, I investigate the compensating wage differential for one particularly valuable benefit, employer-provided health insurance. I find that even after controlling for an extensive set of productivity factors, I obtain results indicating a wrong-signed tradeoff. Those who lose health insurance through the job change also lose wages relative to other displaced workers, while those who gain health insurance also gain in wages. Individuals expected to incur higher health care costs (older workers and workers who are likely to buy family coverage) do not experience steeper wage/health insurance tradeoffs as would be expected if employers were able to pass health care costs on to workers according to individual costs. Although this exercise fails to isolate a wage/fringe tradeoff, the strong correlation between changes in wages and changes in fringe benefits has important implications for public policy towards displaced workers. Further research is needed to understand the true magnitude and distribution of the costs of job displacement taking changes in fringe benefits into account.
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Affiliation(s)
- K I Simon
- Department of Policy Analysis and Management, MVR Hall, Cornell University, Ithaca, NY 14853, USA.
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Abstract
In this paper, we discuss some important data sets that can be used by economists interested in conducting research in health economics. We describe six types of data sets: health components of data sets traditionally used by economists; longitudinal surveys of health and economic behavior; data on employer-provided insurance; cross-sectional surveys of households that focus on health; data on health care providers; and vital statistics. We summarize some of the leading surveys, discuss the availability of the data, identify how researchers have utilized these data and when possible, include a web address that contains more detailed information about each survey.
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Affiliation(s)
- W N Evans
- University of Maryland, College Park, Maryland, USA.
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