Relationship between insurance and access and cost of care in patients with diabetes before and after the affordable care act

2020 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Arjun Varadarajan ◽  
Rebekah J. Walker ◽  
Joni S. Williams ◽  
Kinfe Bishu ◽  
Sneha Nagavally ◽  
...  
Keyword(s):  
Affordable Care Act ◽  
Private Insurance ◽  
Insurance Coverage ◽  
Prescription Medicine ◽  
Usual Source Of Care ◽  
Content Type ◽  
Before And After ◽  
Patients With Diabetes ◽  
Source Of Care ◽  
Over Time

PurposeThe purpose of this paper is to examine the influence of insurance coverage changes over time for patients with diabetes on expenditures and access to care before and after the Affordable Care Act (ACA).Design/methodology/approachThe Medical Expenditure Panel Survey (MEPS) from 2002–2017 was used. Access included having a usual source of care, having delay in care or having delay in obtaining prescription medicine. Expenditures included inpatient, outpatient, office-based, prescription and emergency costs. Panels were broken into four time categories: 2002–2005 (pre-ACA), 2006–2009 (pre-ACA), 2010–2013 (post-ACA) and 2014–2017 (post-ACA). Logistic models for access and two-part regression models for cost were used to understand differences by insurance type over time.FindingsType of insurance changed significantly over time, with an increase for public insurance from 30.7% in 2002–2005 to 36.5% in 2014–2017 and a decrease in private insurance from 62.4% in 2002–2005 to 58.2% in 2014–2017. Compared to those with private insurance, those who were uninsured had lower inpatient ($2,147 less), outpatient ($431 less), office-based ($1,555 less), prescription ($1,869 less) and emergency cost ($92 less). Uninsured were also more likely to have delay in getting medical care (OR = 2.22; 95% CI 1.86, 3.06) and prescription medicine (OR = 1.85; 95% CI 1.53, 2.24) compared with privately insured groups.Originality/valueThough insurance coverage among patients with diabetes did not increase significantly, the type of insurance changed overtime and fewer individuals reported having a usual source of care. Uninsured individuals spent less across all cost types and were more likely to report delay in care despite the passage of the ACA.

scholarly journals Healthcare Access and Utilization among Korean Americans: The Mediating Role of English Use and Proficiency

2016 ◽  
Vol 4 (1) ◽  
pp. 83 ◽  
Author(s):  
Jiang Li ◽  
Annette E. Maxwell ◽  
Beth A. Glenn ◽  
Alison K. Herrmann ◽  
L Cindy Chang ◽  
...  
Keyword(s):  
Health Insurance ◽  
Length Of Stay ◽  
Health Services ◽  
Insurance Coverage ◽  
Korean Americans ◽  
Usual Source Of Care ◽  
Mediating Role ◽  
Usual Source ◽  
The Us ◽  
Source Of Care

The literature suggests that Korean Americans underutilize health services. Cultural factors and language barriers appear to influence this pattern of low utilization but studies on the relationships among length of stay in the US, English use and proficiency, and utilization of health services among Korean Americans have yielded inconsistent results. This study examines whether English language use and proficiency plays a mediating role in the relationships between length of stay in the US and health insurance coverage, access to and use of care. Structural equation modeling was used for mediation analysis with multiple dependent variables among Korean Americans (N= 555) using baseline data from a large trial designed to increase Hepatitis B testing. The results show 36% of the total effect of proportion of lifetime in the US on having health insurance was significantly mediated by English use and proficiency (indirect effect =0.166, SE= 0.07, p<.05; direct effect=0.296, SE= 0.13, p<.05). Proportion of lifetime in the US was not associated with usual source of care and health service utilization. Instead, health care utilization was primarily driven by having health insurance and a usual source of care, further underscoring the importance of these factors. A focus on increasing English use and proficiency and insurance coverage among older, female, less educated Korean Americans has the potential to mitigate health disparities associated with reduced access to health services in this population.

scholarly journals Patterns of Coverage Gains Among Young Adult Cancer Patients Following the Affordable Care Act

2019 ◽  
Vol 3 (1) ◽  
Author(s):  
Leticia M Nogueira ◽  
Neetu Chawla ◽  
Xuesong Han ◽  
Ahmedin Jemal ◽  
K Robin Yabroff
Keyword(s):  
Young Adult ◽  
Cancer Patients ◽  
Affordable Care Act ◽  
Private Insurance ◽  
Insurance Coverage ◽  
Temporal Patterns ◽  
Patients Âgés ◽  
The Affordable Care Act ◽  
Young Adult Cancer ◽  
The Impact

Abstract The dependent coverage expansion (DCE) and Medicaid expansions (ME) under the Affordable Care Act (ACA) may differentially affect eligibility for health insurance coverage in young adult cancer patients. Studies examining temporal patterns of coverage changes in young adults following these policies are lacking. We used data from the National Cancer Database 2003–2015 to conduct a quasi-experimental study of cancer patients ages 19–34 years, grouped as DCE-eligible (19- to 25-year-olds) and DCE-ineligible (27- to 34-year-olds). Although private insurance coverage in DCE-eligible cancer patients increased incrementally following DCE implementation (0.5 per quarter; P < .001), an immediate effect on Medicaid coverage gains was observed after ME in all young adult cancer patients (3.01 for DCE-eligible and 1.62 for DCE-ineligible, both P < .001). Therefore, DCE and ME each had statistically significant and distinct effects on insurance coverage gains. Distinct temporal patterns of ACA policies’ impact on insurance coverage gains likely affect patterns of receipt of cancer care. Temporal patterns should be considered when evaluating the impact of health policies.

30 years of contemporary hospitality management

2019 ◽  
Vol 31 (7) ◽  
pp. 2641-2665 ◽  
Author(s):  
Faizan Ali ◽  
Eunhye (Olivia) Park ◽  
Junehee Kwon ◽  
Bongsug (Kevin) Chae
Keyword(s):  
Topic Modeling ◽  
Relative Weight ◽  
Hospitality Management ◽  
Academic Journal ◽  
Research Topics ◽  
Content Type ◽  
Before And After ◽  
Hospitality And Tourism ◽  
Published Research ◽  
Over Time

Purpose This paper aims to showcase the trends in the research topics and their contributors over a time period of 30 years in the International Journal of Contemporary Hospitality Management (IJCHM). To be specific, this paper uncovers IJCHM’s latent topics and hidden patterns in published research and highlights the differences across three decades and before and after Social Sciences Citation indexing. Design/methodology/approach In total, 1,573 documents published over 199 issues of IJCHM were analyzed using two computational tools, i.e. metaknowledge and structural topic modeling (STM), as the basis of the mixed method. STM was used to discover the evolution of topics over time. Moreover, bibliometrics (and network analysis) were used to highlight IJCHM’s top researchers, top-cited references, the geographical networks of the researchers and differences in the collaborative networks. Findings The number of papers published continually increased over time with changes of key researchers publishing in IJCHM. The co-authorship networks have also changed and revealed an increasing diversity of authorship and collaborations among authors in different countries. Moreover, the variety of topics and the relative weight of each topic have also changed. Research limitations/implications Based on the findings of this study, theoretical and practical implications for hospitality and tourism researchers are provided. Originality/value It is the first attempt to apply topic modeling to a leading academic journal in hospitality and tourism and explore the diversity in contemporary hospitality management research (topics and contributors) from 30 years of published research.

scholarly journals The Evolution of Medical Spending Risk

2009 ◽  
Vol 23 (4) ◽  
pp. 25-48 ◽  
Author(s):  
Jonathan Gruber ◽  
Helen Levy
Keyword(s):  
Health Insurance ◽  
Medical Care ◽  
Low Income ◽  
Private Insurance ◽  
Insurance Coverage ◽  
Health Spending ◽  
The United States ◽  
Consumer Expenditure ◽  
Out Of Pocket Payments ◽  
Over Time

How has the economic risk of health spending changed over time for U.S. households? We describe trends in aggregate health spending in the United States and how private insurance markets and public insurance programs have changed over time. We then present evidence from Consumer Expenditure Survey microdata on how the distribution of household spending on health—that is, out-of-pocket payments for medical care plus the household's share of health insurance premiums—has changed over time. This distribution has shifted up over time—households spend more on medical care and insurance than they used to—but for the purposes of measuring change in risk, it is not the mean but the dispersion of this distribution that is of interest. We consider two measures of dispersion that serve as proxies for household risk: the standard deviation of the distribution of household health spending and the ratio of the 90th percentile of spending to the median (the so-called “90/50 gap”). We find, surprisingly, that neither has increased despite the rapid rise in aggregate health spending. This conclusion holds true for broad subgroups of the population (for example, the nonelderly as a group) but not for some narrowly-defined subgroups (for example, low-income families with children). We next consider how much risk households should face, from the perspective of economic efficiency. Household risk may not have changed much over the past several decades, but do we have any evidence that this level represents either too much or too little risk? Finally, we discuss implications for public policy—in particular, for current debates over expanding health insurance coverage to the uninsured.

Insurance Coverage, Usual Source of Care, and Receipt of Clinically Indicated Care for Comorbid Conditions Among Adults Living With Human Immunodeficiency Virus

Medical Care ◽  
2005 ◽  
Vol 43 (4) ◽  
pp. 401-410 ◽  
Author(s):  
Ris?? B. Goldstein ◽  
Mary Jane Rotheram-Borus ◽  
Mallory O. Johnson ◽  
Lance S. Weinhardt ◽  
Robert H. Remien ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Insurance Coverage ◽  
Usual Source Of Care ◽  
Comorbid Conditions ◽  
Usual Source ◽  
Immunodeficiency Virus ◽  
Source Of Care

scholarly journals Have the ACA's Exchanges Succeeded? It's Complicated

2020 ◽  
Vol 45 (4) ◽  
pp. 661-676 ◽  
Author(s):  
David K. Jones ◽  
Sarah H. Gordon ◽  
Nicole Huberfeld
Keyword(s):  
Health Insurance ◽  
Affordable Care Act ◽  
Health Reform ◽  
Private Insurance ◽  
Insurance Coverage ◽  
Rapid Evolution ◽  
Middle Income ◽  
State Variation ◽  
Individual Decisions ◽  
Insurance Exchanges

Abstract The fight over health insurance exchanges epitomizes the rapid evolution of health reform politics in the decade since the passage of the Affordable Care Act (ACA). The ACA's drafters did not expect the exchanges to be contentious because they would expand private insurance coverage to low- and middle-income individuals who were increasingly unable to obtain employer-sponsored health insurance. Instead, exchanges became one of the primary fronts in the war over Obamacare. Have the exchanges been successful? The answer is not straightforward and requires a historical perspective through a federalism lens. What the ACA has accomplished has depended largely on whether states were invested in or resistant to implementation, as well as individual decisions by state leaders working with federal officials. Our account demonstrates that the states that have engaged with the ACA most consistently appear to have experienced greater exchange-related success. But each aspect of states' engagement with or resistance to the ACA must be counted to fully paint this picture, with significant variation among states. This variation should give pause to those considering next steps in health reform, because state variation can mean innovation and improvement but also lack of coverage, disparities, and diminished access to care.

Sign in / Sign up

Export Citation Format

Share Document