General Health Care Utilization Among Nonelderly Cancer Survivors Before and After Affordable Care Act Implementation: Early Results

PURPOSE: The number of nonelderly cancer survivors is expected to grow and so are their health care costs. Many cancer survivors worry about medical bills. This study examined the impact of the Affordable Care Act (ACA) on the rate of insurance, average annual health care expenditure, and patient care experience among cancer survivors and investigated the patient characteristics that were associated with highly rated care experiences before and after ACA implementation. METHODS: The study is a cross-sectional analysis of adult, nonelderly cancer survivors in the 2011 and 2016 Medical Expenditure Panel Survey who completed health care experience questionnaires. Percent covered by insurance both before and after the ACA was calculated, including total out-of-pocket (OOP) expenses as a percentage of overall health care expenditure per patient. Regression was performed to determine characteristics associated with patient experience ratings. RESULTS: Health insurance coverage for cancer survivors was higher in 2016 than in 2011 (98.4% v 94.4%; P = .006). OOP spending as a percentage of health care expenditure among those with expenses decreased and was most striking in those with no insurance. Privately insured individuals were 3 times as likely to rate their care experience high compared with those with no insurance (odds ratio, 3.31; P < .0001). Those with above-average ratings of self-health and with few comorbidities rated their care experiences highly. CONCLUSION: After the ACA, OOP costs have decreased for all types of insurance coverage. The association between patient experience and health status warrants additional study to better manage and coordinate the care of such patients.

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Does Industrial Air Pollution Increase Health Care Expenditure? Evidence From China

Frontiers in Public Health ◽

10.3389/fpubh.2021.695664 ◽

2021 ◽

Vol 9 ◽

Author(s):

Jin-Sheng Shen ◽

Qun Wang ◽

Han-Pu Shen

Keyword(s):

Health Care ◽

Air Pollution ◽

Health Care Expenditure ◽

Random Effect ◽

Random Effect Model ◽

Medical Expenditure ◽

Added Value ◽

Western China ◽

Effect Model ◽

The Impact

This paper discusses the impact of air pollution on medical expenditure in eastern, central, and western China by applying the fixed-effect model, random-effect model, and panel threshold regression model. According to theoretical and empirical analyses, there are different relationships between the two indexes in different regions of China. For eastern and central regions, it is obvious that the more serious the air pollution is, the more medical expenses there are. However, there is a non-linear single threshold effect between air pollution and health care expenditure in the western region. When air pollution is lower than this value, there is a negative correlation between them. Conversely, the health care expenditure increases with the aggravation of air pollution, but the added value is not enough to make up for the health problems caused by air pollution. The empirical results are basically consistent with the theoretical analysis, which can provide enlightenment for the government to consider the role of air pollution in medical expenditure. Policymakers should arrange the medical budget reasonably, according to its situation, to make up for the loss caused by air pollution.

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Developing An Analytic Approach to Understanding the Patient Care Experience

Journal of Patient Experience ◽

10.1177/2374373516685956 ◽

2016 ◽

Vol 3 (4) ◽

pp. 151-154 ◽

Cited By ~ 1

Author(s):

Mary Kate Springman ◽

Yalissa Bermeo ◽

Heather M Limper ◽

Alison S Tothy

Keyword(s):

Health Care ◽

Patient Satisfaction ◽

Patient Care ◽

Patient Experience ◽

Medical Center ◽

Analytic Approach ◽

Care Experience ◽

Patient Voice ◽

Reporting Tool ◽

The Impact

The amount of data available to health-care institutions regarding the patient care experience has grown tremendously. Purposeful approaches to condensing, interpreting, and disseminating these data are becoming necessary to further understand how clinical and operational constructs relate to patient satisfaction with their care, identify areas for improvement, and accurately measure the impact of initiatives designed to improve the patient experience. We set out to develop an analytic reporting tool deeply rooted in the patient voice that would compile patient experience data obtained throughout the medical center.

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The Impacts of the COVID-19 Pandemic on the Medical Expenditure Panel Survey

American Journal of Public Health ◽

10.2105/ajph.2021.306534 ◽

2021 ◽

Vol 111 (12) ◽

pp. 2157-2166

Author(s):

Samuel H. Zuvekas ◽

David Kashihara

Keyword(s):

Health Care ◽

Medical Expenditure Panel Survey ◽

Insurance Coverage ◽

Response Rates ◽

Medical Expenditure ◽

Care Utilization ◽

Panel Survey ◽

Quality Of Data ◽

Statistical Precision ◽

The Impact

The COVID-19 pandemic caused substantial disruptions in the field operations of all 3 major components of the Medical Expenditure Panel Survey (MEPS). The MEPS is widely used to study how policy changes and major shocks, such as the COVID-19 pandemic, affect insurance coverage, access, and preventive and other health care utilization and how these relate to population health. We describe how the MEPS program successfully responded to these challenges by reengineering field operations, including survey modes, to complete data collection and maintain data release schedules. The impact of the pandemic on response rates varied considerably across the MEPS. Investigations to date show little effect on the quality of data collected. However, lower response rates may reduce the statistical precision of some estimates. We also describe several enhancements made to the MEPS that will allow researchers to better understand the impact of the pandemic on US residents, employers, and the US health care system. (Am J Public Health. 2021;111(12):2157–2166. https://doi.org/10.2105/AJPH.2021.306534 )

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Risk of Negative Health Outcomes and High Costs for People With Diabetes and Unmet Psychological Needs in the United States

Diabetes Spectrum ◽

10.2337/ds21-0019 ◽

2022 ◽

Author(s):

Aryana Sepassi ◽

Mark Bounthavong ◽

Renu F. Singh ◽

Mark Heyman ◽

Kristin Beizai ◽

...

Keyword(s):

Health Care ◽

Resource Utilization ◽

Health Care Expenditure ◽

Population Level ◽

The United States ◽

Psychological Needs ◽

Medical Expenditure ◽

Psychological Need ◽

Total Health Care Expenditure ◽

The Impact

Measuring the population-level relationship between compromised mental health and diabetes care remains an important goal for clinicians and health care decision-makers. We evaluated the impact of self-reported unmet psychological need on health care resource utilization and total health care expenditure in people with type 2 diabetes. Patients who reported unmet psychological needs were more likely than those who did not to incur a higher annual medical expenditure, have greater resource utilization, and have a higher risk of all-cause mortality.

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The impact of Health Sector Evolution Plan on the performance of hospitals in Iran

International Journal of Health Governance ◽

10.1108/ijhg-09-2017-0046 ◽

2018 ◽

Vol 23 (2) ◽

pp. 111-119 ◽

Cited By ~ 2

Author(s):

Satar Rezaei ◽

Mohammad Hajizadeh ◽

Mohammad Bazyar ◽

Ali Kazemi Karyani ◽

Behrooz Jahani ◽

...

Keyword(s):

Health Care ◽

Average Length ◽

Health Care Expenditure ◽

Health Sector ◽

Poor Performance ◽

Content Type ◽

Average Length Of Stay ◽

Before And After ◽

Recent Reform ◽

The Impact

Purpose The Health Sector Evolution Plan (HSEP) is the most recent reform in Iran’s health care system that was launched in May 2014 in all university-affiliated hospitals to reduce health care expenditure for patients, while improving the efficiency and quality of hospital services. The purpose of this paper is to evaluate the impact of the HSEP on the performance of 15 hospitals affiliated with Kermanshah University of Medical Sciences (KUMS), located in the western region of Iran. Design/methodology/approach The Pabon Lasso model was used to measure the performance of hospitals before and after the implementation of the HSEP in 2013-2014 and 2015-2016, respectively. Three indicators of average length of stay (ALoS), bed occupancy rate (BOR) and bed turnover rate (BTR) were analyzed by the Pabon Lasso model. Findings The results showed that the average ALoS, BTR and BOR before the introduction of the HSEP were 2.59 days, 92 times and 57 percent, respectively, and the corresponding figures for these indicators after the implementation of the HSEP were 2.61 days, 98.9 times and 59.9 percent. The results indicated that before the introduction of the HESP, 40 percent of hospitals were in zone 1 (poor performance: low BTR and BOR and high ALoS), 27 percent in zone 2, 20 percent in zone 3 (good performance: high BTR and BOR and low ALoS) and 13 percent in zone 4. After the HSEP, the proportion of hospitals in zones 1-4 was 33, 27, 20 and 20 percent, respectively. Originality/value This study is the first to use the Pabon Lasso model technique to evaluate the impact of the HSEP on hospitals affiliated with KUMS.

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Trends in Insurance Status Among Patients Diagnosed With Cancer Before and After Implementation of the Affordable Care Act

Journal of Oncology Practice ◽

10.1200/jop.2017.027102 ◽

2018 ◽

Vol 14 (2) ◽

pp. e92-e102 ◽

Cited By ~ 14

Author(s):

Haley A. Moss ◽

Laura J. Havrilesky ◽

S. Yousuf Zafar ◽

Gita Suneja ◽

Junzo Chino

Keyword(s):

Breast Cancer ◽

Affordable Care Act ◽

Insurance Coverage ◽

Insurance Status ◽

Medicaid Expansion ◽

Before And After ◽

Medicaid Eligibility ◽

The Affordable Care Act ◽

Insurance Rates ◽

The Impact

Purpose: The Affordable Care Act (ACA) aimed to increase insurance coverage through key provisions such as expansion of Medicaid eligibility and enforcement of an individual mandate. The objective of this study is to examine the impact of the ACA on insurance rates among patients newly diagnosed with colon, lung, or breast cancer. Methods: Using the SEER database, patients younger than age 65 years diagnosed with colon, lung, or breast cancer between 2008 and 2014 were identified. Insurance rates were examined before versus after passage of the ACA (2011) and before (2011 to 2013) versus after (2014) Medicaid expansion in nine expansion states and five nonexpansion states. Difference-in-differences models were used to estimate the differential impact of ACA in expansion compared with nonexpansion states. Results: A total of 414,085 patients with known insurance status were diagnosed with colon, lung, or breast cancer between 2008 and 2014. For all cancer types, there was a significant increase in patients enrolled in Medicaid after 2011 in expansion states. Between 2011 to 2013 and 2014, in patients living in states with Medicaid expansion, the uninsured rates decreased by ≥ 50% among patients with a new diagnosis of lung and colon cancer (6.5% in 2011 to 2013 to 3.1% in 2014 and 6.8% in 2011 to 2013 to 3.4% in 2014, respectively; P < .001); the uninsured rate decreased to a lesser degree for patients with breast cancer (2.7% in 2011 to 2013 to 1.6% in 2014; P < .001). This decrease in the rate of uninsured patients was absent in patients living in nonexpansion states. Conclusion: The ACA resulted in expanded insurance coverage for patients diagnosed with colon, lung, and breast cancer. However, the impact was only observed in states that increased their Medicaid eligibility.

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Impact of comorbid conditions on health care expenditure and work-related outcomes in patients with rheumatoid arthritis

The Journal of Rheumatology ◽

10.3899/jrheum.200231 ◽

2020 ◽

pp. jrheum.200231

Author(s):

Martin Vu ◽

Natalie Carvalho ◽

Philip M. Clarke ◽

Rachelle Buchbinder ◽

An Tran-Duy

Keyword(s):

Rheumatoid Arthritis ◽

Heart Failure ◽

Health Care ◽

Negative Binomial ◽

Medical Expenditure Panel Survey ◽

Health Care Expenditure ◽

Medical Expenditure ◽

Comorbid Conditions ◽

Work Related ◽

The Impact

Objective To evaluate the impact of comorbid conditions on direct health care expenditure and work-related outcomes in patients with rheumatoid arthritis (RA). Methods This was a retrospective analysis of the Medical Expenditure Panel Survey from 2006 to 2015 in 4,967 adult RA patients in the USA. Generalised linear models were used for health care expenditure and income, logistic model for employment status, and zero-inflated negative binomial model for absenteeism. Thirteen comorbid conditions were included as potential predictors of direct cost and work-related outcomes. The models were adjusted for sociodemographic factors including sex, age, region, marital status, race/ethnicity, income, education and smoking status. Results RA patients with heart failure had the highest incremental annual health care expenditure (US$8,205; 95% CI, US$3,683-US$12,726) compared to those without the condition. Many comorbid conditions including hypertension, diabetes, depression, obstructive pulmonary disease, cancer, stroke and heart failure reduced the chance of RA patients aged between 18-64 years being employed. Absenteeism of employed RA patients was significantly affected by hypertension, depression, disorders of the eye and adnexa or stroke. On average, an RA patient with heart failure earned US$15,833 (95% CI, US$4,435- US$27,231) per year less than an RA patient without heart failure. Conclusion Comorbid conditions in RA patients were associated with higher annual health care expenditure, lower likelihood of employment, higher rates of absenteeism and lower income. Despite its low prevalence, heart failure was associated with the highest incremental health care expenditure and the lowest likelihood of being employed compared to other common comorbid conditions.

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Disparities in Insurance Coverage, Health Services Use, and Access Following Implementation of the Affordable Care Act: A Comparison of Disabled and Nondisabled Working-Age Adults

INQUIRY The Journal of Health Care Organization Provision and Financing ◽

10.1177/0046958017734031 ◽

2017 ◽

Vol 54 ◽

pp. 004695801773403 ◽

Cited By ~ 2

Author(s):

Jae Kennedy ◽

Elizabeth Geneva Wood ◽

Lex Frieden

Keyword(s):

Health Care ◽

Affordable Care Act ◽

Health Care Access ◽

Insurance Coverage ◽

Adults With Disabilities ◽

Full Implementation ◽

Care Access ◽

Before And After ◽

Working Age ◽

The Affordable Care Act

The objective of this study was to assess trends in health insurance coverage, health service utilization, and health care access among working-age adults with and without disabilities before and after full implementation of the Affordable Care Act (ACA), and to identify current disability-based disparities following full implementation of the ACA. The ACA was expected to have a disproportionate impact on working-age adults with disabilities, because of their high health care usage as well as their previously limited insurance options. However, most published research on this population does not systematically look at effects before and after full implementation of the ACA. As the US Congress considers new health policy reforms, current and accurate data on this vulnerable population are essential. Weighted estimates, trend analyses and analytic models were conducted using the 1998-2016 National Health Interview Surveys (NHIS) and the 2014 Medical Expenditure Panel Survey. Compared with working-age adults without disabilities, those with disabilities are less likely to work, more likely to earn below the federal poverty level, and more likely to use public insurance. Average health costs for this population are 3 to 7 times higher, and access problems are far more common. Repeal of key features of the ACA, like Medicaid expansion and marketplace subsidies, would likely diminish health care access for working-age adults with disabilities.

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