Measuring Efforts of Nonprofit Hospitals to Address Opioid Abuse After the Affordable Care Act

Objectives: To assess the strategies that nonprofit hospitals are adopting to address opioid abuse after requirements for community engagement expanded in the Affordable Care Act. Methods: We constructed a dataset of implementation activities for a 20% random sample of nonprofit hospitals in the United States. Using logistic regression, we assessed the extent to which strategies adopted are new, existing, or primarily partnerships. Using negative binomial regression, we assessed the total number of strategies adopted. We controlled for hospital and community characteristics as well as state policies related to opioid abuse. Results: Most strategies adopted by hospitals were new and clinical in nature and the most common number of strategies adopted was one. Hospitals in the Northeast were more likely to adopt a higher number of strategies and to partner with community-based organizations. Hospitals that partner with community-based organizations were more likely to adopt strategies that engage in harm reduction, targeted risk education, or focus on addressing social determinants of health. Conclusions: Community, institutional, and state policy characteristics predict hospital involvement in addressing opioid abuse. These findings underscore several opportunities to support hospital-led interventions to address opioid abuse.

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Health Insurance Coverage before and after the Affordable Care Act in the USA

Sci ◽

10.3390/sci3020025 ◽

2021 ◽

Vol 3 (2) ◽

pp. 25

Author(s):

Jesse Patrick ◽

Philip Q. Yang

Keyword(s):

Health Insurance ◽

National Health ◽

Affordable Care Act ◽

The United States ◽

Insurance Status ◽

Health Insurance Status ◽

Full Implementation ◽

Before And After ◽

The Affordable Care Act ◽

Partial Implementation

The Affordable Care Act (ACA) is at the crossroads. It is important to evaluate the effectiveness of the ACA in order to make rational decisions about the ongoing healthcare reform, but existing research into its effect on health insurance status in the United States is insufficient and descriptive. Using data from the National Health Interview Surveys from 2009 to 2015, this study examines changes in health insurance status and its determinants before the ACA in 2009, during its partial implementation in 2010–2013, and after its full implementation in 2014 and 2015. The results of trend analysis indicate a significant increase in national health insurance rate from 82.2% in 2009 to 89.4% in 2015. Logistic regression analyses confirm the similar impact of age, gender, race, marital status, nativity, citizenship, education, and poverty on health insurance status before and after the ACA. Despite similar effects across years, controlling for other variables, youth aged 26 or below, the foreign-born, Asians, and other races had a greater probability of gaining health insurance after the ACA than before the ACA; however, the odds of obtaining health insurance for Hispanics and the impoverished rose slightly during the partial implementation of the ACA, but somewhat declined after the full implementation of the ACA starting in 2014. These findings should be taken into account by the U.S. Government in deciding the fate of the ACA.

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The Impact of the Affordable Care Act Medicaid Expansions on the Sources of Health Insurance Coverage of Undergraduate Students in the United States

Medical Care Research and Review ◽

10.1177/10775587211015816 ◽

2021 ◽

pp. 107755872110158

Author(s):

Priyanka Anand ◽

Dora Gicheva

Keyword(s):

United States ◽

Health Insurance ◽

Undergraduate Students ◽

Affordable Care Act ◽

Insurance Coverage ◽

Health Insurance Coverage ◽

The United States ◽

Percentage Points ◽

The Affordable Care Act ◽

Medicaid Expansions

This article examines how the Affordable Care Act Medicaid expansions affected the sources of health insurance coverage of undergraduate students in the United States. We show that the Affordable Care Act expansions increased the Medicaid coverage of undergraduate students by 5 to 7 percentage points more in expansion states than in nonexpansion states, resulting in 17% of undergraduate students in expansion states being covered by Medicaid postexpansion (up from 9% prior to the expansion). In contrast, the growth in employer and private direct coverage was 1 to 2 percentage points lower postexpansion for students in expansion states compared with nonexpansion states. Our findings demonstrate that policy efforts to expand Medicaid eligibility have been successful in increasing the Medicaid coverage rates for undergraduate students in the United States, but there is evidence of some crowd out after the expansions—that is, some students substituted their private and employer-sponsored coverage for Medicaid.

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Analyzing patient choices for routine procedures in the United States vs overseas before and after the affordable care act: a case study

Health Systems ◽

10.1057/hs.2015.7 ◽

2016 ◽

Vol 5 (1) ◽

pp. 21-28 ◽

Cited By ~ 1

Author(s):

Sameer Kumar ◽

Muer Yang

Keyword(s):

United States ◽

Affordable Care Act ◽

The United States ◽

Before And After ◽

The Affordable Care Act ◽

Routine Procedures

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Effect of a Fall Prevention Program on Balance Maintenance Using a Quasi-experimental Design in Real-World Settings

Journal of Aging and Health ◽

10.1177/0898264312436713 ◽

2012 ◽

Vol 24 (5) ◽

pp. 827-845 ◽

Cited By ~ 5

Author(s):

Yvonne Robitaille ◽

Michel Fournier ◽

Sophie Laforest ◽

Lise Gauvin ◽

Johanne Filiatrault ◽

...

Keyword(s):

Real World ◽

Fall Prevention ◽

Prevention Program ◽

Negative Binomial ◽

Negative Binomial Regression ◽

Community Dwelling ◽

Balance Performance ◽

Community Based ◽

Fall Prevention Program ◽

Quasi Experimental

Objectives: To examine the effect of a fall prevention program offered under real-world conditions on balance maintenance several months after the program. To explore the program’s impact on falls. Method: A quasi-experimental study was conducted among community-dwelling seniors, with pre- and postintervention measures of balance performance and self-reported falls. Ten community-based organizations offered the intervention (98 participants) and 7 recruited participants to the study’s control arm (102 participants). An earlier study examined balance immediately after the 12-week program. The present study focuses on the 12-month effect. Linear regression (balance) and negative binomial regression (falls) procedures were performed.falls. Results: During the 12-month study period, experimental participants improved and maintained their balance as reflected by their scores on three performance tests. There was no evidence of an effect on falls.falls. Discussion: Structured group exercise programs offered in community-based settings can maintain selected components of balance for several months after the program’s end.

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Injury-related falls from bicycles, skateboards, roller skates, and non-motorized scooters in the United States: 2005 - 2014

Journal of Epidemiological Research ◽

10.5430/jer.v4n1p16 ◽

2017 ◽

Vol 4 (1) ◽

pp. 16

Author(s):

William Milczarski ◽

Peter Tuckel ◽

Richard Maisel

Keyword(s):

Public Health ◽

New York ◽

Negative Binomial ◽

Local Level ◽

Specific Treatment ◽

Negative Binomial Regression ◽

The United States ◽

Treatment Modalities ◽

Public Health Officials ◽

National Databases

Purpose: To provide an updated and comparative analysis of injury-related falls from bicycles, skateboards, roller skates and non-motorized scooters.Methods: The study uses two national databases – the Nationwide Emergency Department Sample and the Nationwide Inpatient Sample – and subnational databases for New York, California, and Maryland. Univariate and multivariate analyses (negative binomial regression) are performed to identify effects of age, gender, racial-ethnic background, and region on the incidence of injury-related falls from each of the four devices.Results: The rate of injuries due to falls from bicycles far surpasses the rates due to falls from the other devices. When a measure of “exposure” is taken into consideration, however, the rate of injuries from skateboards outstrips the rates from bicycles or roller skates. The profile of patients who are injured from falls from each of the four devices is distinctive. Asian-Americans are greatly underrepresented among those who suffer a fall-related injury from any of the four devices. The incidence of injuries attributable to falls varies considerably by geographic region.Conclusions: Public health officials need to be mindful that while certain activities such as scootering might be gaining in popularity, the number of injuries sustained from bicycles still dwarfs the number attributable to falls from skateboards, roller skates, and scooters combined. Thus special attention needs to be paid to both prevent falls from bicycles and specific treatment modalities. It is important for public health officials to gather injury data at the local level to allocate prevention and treatment resources more efficiently.

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Trends in Opioid Prescribing Among Hemodialysis Patients, 2007–2014

American Journal of Nephrology ◽

10.1159/000495353 ◽

2018 ◽

Vol 49 (1) ◽

pp. 20-31 ◽

Cited By ~ 4

Author(s):

Matthew Daubresse ◽

G. Caleb Alexander ◽

Deidra C. Crews ◽

Dorry L. Segev ◽

Mara A. McAdams-DeMarco

Keyword(s):

Low Income ◽

Negative Binomial ◽

Negative Binomial Regression ◽

The United States ◽

Incidence Rates ◽

Opioid Prescription ◽

Opioid Prescribing ◽

Hispanic Patients ◽

Estimate Annual Incidence ◽

National Trends

Background: Hemodialysis (HD) patients frequently experience pain. Previous studies of HD patients suggest increased opioid prescribing through 2010. It remains unclear if this trend continued after 2010 or declined with national trends. Methods: Longitudinal cohort study of 484,745 HD patients in the United States Renal Data System/Medicare data. We used Poisson/negative binomial regression to estimate annual incidence rates of opioid prescribing between 2007 and 2014. We compared prescribing rates with the general US population using IQVIA’s National Prescription Audit data. Outcomes included the following: percent of HD patients receiving an opioid prescription, rate of opioid prescriptions, quantity, days supply, morphine milligram equivalents (MME) dispensed per 100 person-days, and prescriptions per person. Results: In 2007, 62.4% of HD patients received an opioid prescription. This increased to 63.2% in 2010 then declined to 53.7% by 2014. Opioid quantity peaked in 2011 at 73.5 pills per 100 person-days and declined to 62.6 pills per 100 person-days in 2014. MME peaked between 2010 and 2012 then declined through 2014. In 2014, MME rates were 1.8-fold higher among non-Hispanic patients and 1.6-fold higher among low-income patients. HD patients received 3.2-fold more opioid prescriptions per person compared to the general US population and were primarily prescribed oxycodone and hydrocodone. Between 2012 and 2014, HD patients experienced greater declines in opioid prescriptions per person (18.2%) compared to the general US population (7.1%). Conclusion: Opioid prescribing among HD patients declined between 2012 and 2014. However, HD patients continue receiving substantially more opioids than the general US population.

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Urban Redevelopment Planning and Social Work Practice

10.1093/acrefore/9780199975839.013.1333 ◽

2021 ◽

Author(s):

Laurie A. Walker

Keyword(s):

Social Workers ◽

Local Community ◽

Work Practice ◽

Urban Redevelopment ◽

The United States ◽

Social Work Practice ◽

Community Based ◽

Community Based Organizations ◽

Inclusive Processes ◽

Private Investors

Urban neighborhood disinvestment in the United States resulted in deferred maintenance of buildings and common social problems experienced by residents. Strategies to redevelop neighborhoods include collaboration among many subsystems seeking to collectively invest in places and people. Contemporary federal initiatives focus on incentivizing coordinated investments between existing local community-based organizations, local and federal government, and private investors. Public–private partnerships include anchor institutions with commitments to the long-term success of place-based initiatives who invest their financial, intellectual, social, and political capital. Social workers are embedded in local community-based organizations and relationships with residents in neighborhoods experiencing redevelopment. Social workers can help guide top-down and bottom-up approaches to neighborhood revitalization toward more equitable and inclusive processes and outcomes. Resident engagement in redeveloping neighborhoods takes many forms and requires differing skill sets for social workers. Urban redevelopment is a global trend with common critiques regarding relying on gentrification and market-driven strategies with private investors.

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Association of Medicaid expansion under the Affordable Care Act with access to elective spine surgical care

Journal of Neurosurgery Spine ◽

10.3171/2021.3.spine2122 ◽

2021 ◽

pp. 1-9

Author(s):

Jacob K. Greenberg ◽

Derek S. Brown ◽

Margaret A. Olsen ◽

Wilson Z. Ray

Keyword(s):

United States ◽

Spine Surgery ◽

Surgical Procedures ◽

Affordable Care Act ◽

Surgical Care ◽

The United States ◽

Medicaid Expansion ◽

Percentage Points ◽

The Affordable Care Act ◽

The Impact

OBJECTIVE The Affordable Care Act expanded Medicaid eligibility in many states, improving access to some forms of elective healthcare in the United States. Whether this effort increased access to elective spine surgical care is unknown. This study’s objective was to evaluate the impact of Medicaid expansion under the Affordable Care Act on the volume and payer mix of elective spine surgery in the United States. METHODS This study evaluated elective spine surgical procedures performed from 2011 to 2016 and included in the all-payer State Inpatient Databases of 10 states that expanded Medicaid access in 2014, as well as 4 states that did not expand Medicaid access. Adult patients aged 18–64 years who underwent elective spine surgery were included. The authors used a quasi-experimental difference-in-difference design to evaluate the impact of Medicaid expansion on hospital procedure volume and payer mix, independent of time-dependent trends. Subgroup analysis was conducted that stratified results according to cervical fusion, thoracolumbar fusion, and noninstrumented surgery. RESULTS The authors identified 218,648 surgical procedures performed in 10 Medicaid expansion states and 118,693 procedures performed in 4 nonexpansion states. Medicaid expansion was associated with a 17% (95% CI 2%–35%, p = 0.03) increase in mean hospital spine surgical volume and a 23% (95% CI −0.3% to 52%, p = 0.054) increase in Medicaid volume. Privately insured surgical volumes did not change significantly (incidence rate ratio 1.13, 95% CI −5% to 34%, p = 0.18). The increase in Medicaid volume led to a shift in payer mix, with the proportion of Medicaid patients increasing by 6.0 percentage points (95% CI 4.1–7.0, p < 0.001) and the proportion of private payers decreasing by 6.7 percentage points (95% CI 4.5–8.8, p < 0.001). Although the magnitude of effects varied, these trends were similar across procedure subgroups. CONCLUSIONS Medicaid expansion under the Affordable Care Act was associated with an economically and statistically significant increase in spine surgery volume and the proportion of surgical patients with Medicaid insurance, indicating improved access to care.

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Conclusion

10.5149/northcarolina/9781469661339.003.0009 ◽

2020 ◽

pp. 223-226

Author(s):

Dan Royles

Keyword(s):

Climate Change ◽

United States ◽

Health Equity ◽

Affordable Care Act ◽

The United States ◽

First Year ◽

Communities Of Color ◽

History Of ◽

The Affordable Care Act ◽

Hiv Aids

This chapter considers what it means to write the history of a crisis that has not yet ended, and briefly traces connections among the stories told in previous chapters. It connects these stories to the ongoing fight for health equity in the United States, including the author’s involvement in the fight to preserve the Affordable Care Act in the first year of Donald Trump’s presidency. Finally, it compares HIV/AIDS to climate change, as both are existential crises that will disproportionately affect poor communities of color.

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