The Impact of the Massachusetts Health Care Reform on Health Care Use Among Children

2012 ◽  
Vol 102 (3) ◽  
pp. 502-507 ◽  
Author(s):  
Sarah Miller
Keyword(s):  
Health Care ◽  
Health Care Reform ◽  
Insurance Coverage ◽  
Universal Coverage ◽  
Health Care Use ◽  
Care Utilization ◽  
Adult Health ◽  
Major Health ◽  
Utilization Patterns ◽  
The Impact

In 2006 Massachusetts enacted a major health care reform aimed at achieving near-universal coverage in the state. While other studies have found that this reform substantially affected the use of health services in general, the impact of the reform on children is largely unexplored. Children are of special interest to policymakers because it is widely believed that better health in early childhood results in large payoffs to adult health and achievement. I analyze how the reform affected the insurance coverage, health care utilization patterns, and health outcomes of children under 18 years old.

scholarly journals 3247 Implementing an Interdisciplinary, Student-Run Consult Service for Homeless Patients: The Critical Role of Community Partnerships

2019 ◽  
Vol 3 (s1) ◽  
pp. 91-91
Author(s):  
Frances Loretta Gill
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Hospital Admissions ◽  
Community Partnerships ◽  
Care Utilization ◽  
Consult Service ◽  
Utilization Patterns ◽  
Ed Visits ◽  
Hospital Days ◽  
The Impact

OBJECTIVES/SPECIFIC AIMS: Elucidate the unique challenges associated with hospital discharge planning for patients experiencing homelessness. Assess the impact of robust community partnerships and strong referral pathways on participating patients’ health care utilization patterns in an interdisciplinary, student-run hospital consult service for patients experiencing homelessness. Identify factors (both patient-level and intervention-level) that are associated with successful warm hand-offs to outside social agencies at discharge. METHODS/STUDY POPULATION: To assess the impact of participation in HHL on patients’ health care utilization, we conducted a medical records review using the hospital’s electronic medical record system comparing patients’ health care utilization patterns during the nine months pre- and post- HHL intervention. Utilization metrics included number of ED visits and hospital admissions, number of hospital days, 30-day hospital readmissions, total hospital costs, and follow-up appointment attendance rates, as well as percentage of warm hand-offs to community-based organizations upon discharge. Additionally, we collected data regarding patient demographics, duration of homelessness, and characteristics of homelessness (primarily sheltered versus primarily unsheltered, street homeless versus couch surfing, etc) and intervention outcome data (i.e. percentage of warm hand-offs). This study was reviewed and approved by the Tulane University Institutional Review Board and the University Medical Center Research Review Committee. RESULTS/ANTICIPATED RESULTS: For the first 41 patients who have been enrolled in HHL, participation in HHL is associated with a statistically significant decrease in hospital admissions by 49.4% (p < 0.01) and hospital days by 47.7% (p < 0.01). However, the intervention is associated with a slight, although not statistically significant, increase in emergency department visits. Additionally, we have successfully accomplished warm hand-offs at discharge for 71% percent of these patients. Over the next year, many more patients will be enrolled in HHL, which will permit a more finely grained assessment to determine which aspects of the HHL intervention are most successful in facilitating warm hand-offs and decreased health care utilization amongst patients experiencing homelessness. DISCUSSION/SIGNIFICANCE OF IMPACT: Providing care to patients experiencing homelessness involves working within complex social problems that cannot be adequately addressed in a hospital setting. This is best accomplished with an interdisciplinary team that extends the care continuum beyond hospital walls. The HHL program coordinators believe that ED visits amongst HHL patients and percentage of warm hand-offs are closely related outcomes. If we are able to facilitate a higher percentage of warm hand-offs to supportive social service agencies, we may be able to decrease patient reliance on the emergency department as a source of health care, meals, and warmth. Identifying the factors associated with successful warm hand-offs upon discharge from the hospital may assist us in building on the HHL program’s initial successes to further decrease health care utilization while offering increased interdisciplinary educational opportunities for medical students.

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

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 )

scholarly journals Who Gets Irritable Bowel Syndrome and Does Seeing a Gastroenterologist Affect Its Course?

2001 ◽  
Vol 15 (suppl b) ◽  
pp. 5B-7B
Author(s):  
Charles N Bernstein
Keyword(s):  
Health Care ◽  
Irritable Bowel Syndrome ◽  
Health Care Utilization ◽  
Well Being ◽  
Care Utilization ◽  
Office Visits ◽  
Utilization Patterns ◽  
Irritable Bowel ◽  
The Impact

A review of studies involving patients with irritable bowel syndrome is presented. This review looks at the impact of gastroenterology consultation on health care utilization patterns and the well-being of the patient when followed up over a two-year period. A structured gastroenterological consultation between the physician and patient may decrease the number of office visits for gastrointestinal- related problems.

scholarly journals The Effects of the Massachusetts Health Reform on Household Financial Distress

2016 ◽  
Vol 8 (3) ◽  
pp. 284-313 ◽  
Author(s):  
Bhashkar Mazumder ◽  
Sarah Miller
Keyword(s):  
Health Care ◽  
Health Care Reform ◽  
Financial Distress ◽  
Insurance Coverage ◽  
Age Groups ◽  
Potential Effect ◽  
Third Party ◽  
Financial Outcomes ◽  
Report Data ◽  
The Impact

In this paper, we examine the effect of a major health care reform in Massachusetts on a broad set of financial outcomes using credit report data. We exploit variation in the impact of the reform across counties and age groups using pre-reform insurance coverage as a measure of the potential effect of the reform. We find that the reform reduced the amount of debt that was past due, improved credit scores, reduced personal bankruptcies and reduced third-party collections. Our results show that health care reform has implications that extend well beyond the health of those who gain insurance coverage. (JEL D14, G22, H75, I13, I18)

Measurement and Explanation of Horizontal (In)Equity in Health Care Utilization Among Thais After Universal Coverage Policy Implementation

2010 ◽  
Vol 23 (6) ◽  
pp. 980-995 ◽  
Author(s):  
Tewarit Somkotra
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Insurance Coverage ◽  
Universal Coverage ◽  
Decomposition Methods ◽  
Health Insurance Coverage ◽  
Care Utilization ◽  
Public Facility ◽  
Horizontal Inequity ◽  
The Poor

This study aimed to examine the extent to which income-related inequality and horizontal inequity in outpatient and inpatient care utilization among Thais are manifest after the country implemented the Universal Coverage (UC) policy, by using a concentration index and a horizontal inequity index, respectively. Furthermore, the study examined the determinants and their associations with the observed inequality, if any, in health care utilization through decomposition methods. The nationally representative Health and Welfare Survey 2005 was used to perform the analyses. Although there are socioeconomic gradients in health care utilization among Thais, the findings reveal that health care utilization tends to favor the poor in particular with utilization at the public facility and especially at the primary care level facility. Thailand has made impressive strides toward nearly universal health insurance coverage and improving access to and utilization of health care for its population, particularly among the poor.

scholarly journals Analysis of Composition Change of Public Facility Care Users After the Universal Coverage Scheme in Thailand

SAGE Open ◽  
2020 ◽  
Vol 10 (3) ◽  
pp. 215824402094742
Author(s):  
Natthani Meemon ◽  
Seung Chun Paek
Keyword(s):  
Health Care ◽  
Descriptive Analysis ◽  
Universal Coverage ◽  
Health Care Use ◽  
Public Facility ◽  
Composition Change ◽  
Study Results ◽  
Urban People ◽  
The Impact ◽  
Universal Coverage Scheme

This study conducted a preliminary analysis to examine the impact of Thailand’s Universal Coverage Scheme (UCS) on health care use. In contrast with our expectation, no significant increase was found in the use of public facility care (i.e., use of the UCS services) after the UCS because the UCS increased the use of public facility care for the previously uninsured, but at the same time, it similarly decreased the previously insured who were previous public facility care users. Based on a view of this situation as a composition change of public facility care users, this study investigated where and discussed why the composition change occurred. By classifying health care use into four types (no care, informal care, public facility care, and private facility care), descriptive analysis and pooled logistic regression analysis were performed with data from the Health and Welfare Survey 2001 and 2003 to 2005. The study results showed that the UCS largely increased the use of public facility care for the previous uninsured people. In addition, the degree of the increase was relatively larger in lower income, older, younger, female, and rural people. Meanwhile, the UCS decreased the use of public facility care for previous public facility care users, especially those in higher income, middle-aged (mostly age 20–39 years), male, and urban people. This was probably due to an imbalance between the scaled-up UCS implementation and the resources allocated for improving the capacity of public facilities. This may have created circumstances that did not serve the needs of users (e.g., long waiting time) and pushed those previous users to the private sector.

scholarly journals Impact of Health Insurance Expansion on the Treatment of Colorectal Cancer

2016 ◽  
Vol 34 (34) ◽  
pp. 4110-4115 ◽  
Author(s):  
Andrew P. Loehrer ◽  
Zirui Song ◽  
Alex B. Haynes ◽  
David C. Chang ◽  
Matthew M. Hutter ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Health Care ◽  
Health Care Reform ◽  
Private Insurance ◽  
Insurance Coverage ◽  
The United States ◽  
The Third ◽  
Insured Patients ◽  
The Impact ◽  
Privately Insured

Purpose Colorectal cancer is the third most common cancer and the third leading cause of cancer deaths in the United States. Lack of insurance coverage has been associated with more advanced disease at presentation, more emergent admissions at time of colectomy, and lower survival relative to privately insured patients. The 2006 Massachusetts health care reform serves as a unique natural experiment to assess the impact of insurance expansion on colorectal cancer care. Methods We used the Hospital Cost and Utilization Project State Inpatient Databases to identify patients with colorectal cancer with government-subsidized or self-pay (GSSP) or private insurance admitted to a hospital between 2001 and 2011 in Massachusetts (n = 17,499) and three control states (n = 144,253). Difference-in-differences models assessed the impact of the 2006 Massachusetts coverage expansion on resection of colorectal cancer, controlling for confounding factors and secular trends. Results Before the 2006 Massachusetts reform, government-subsidized or self-pay patients had significantly lower rates of resection for colorectal cancer compared with privately insured patients in both Massachusetts and the control states. The Massachusetts insurance expansion was associated with a 44% increased rate of resection (rate ratio = 1.44; 95% CI, 1.23 to 1.68; P < .001), a 6.21 percentage point decreased probability of emergent admission (95% CI, −11.88 to −0.54; P = .032), and an 8.13 percentage point increased probability of an elective admission (95% CI, 1.34 to 14.91; P = .019) compared with the control states. Conclusion The 2006 Massachusetts health care reform, a model for the Affordable Care Act, was associated with increased rates of resection and decreased probability of emergent resection for colorectal cancer. Our findings suggest that insurance expansion may help improve access to care for patients with colorectal cancer.

Health Care Use by Children Receiving Mental Health Services

PEDIATRICS ◽  
1990 ◽  
Vol 85 (1) ◽  
pp. 114-118 ◽  
Author(s):  
Kelly Kelleher ◽  
Barbara Starfield
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Medical Care ◽  
Mental Health Treatment ◽  
Psychosocial Problems ◽  
Important Variable ◽  
Health Care Use ◽  
Care Utilization ◽  
Health Treatment ◽  
The Impact

Reduction in medical care utilization is one criteria for assessing the impact of mental health treatment for children with psychosocial problems. This reduction has been termed the "offset" effect. Almost all published research concerning offset after mental health treatment concerns adults, and the few studies in pediatric populations are limited by methodologic problems. A study of health care utilization after mental health treatment for children was conducted. Mental health treatment for psychosocial problems was significantly associated with decreased use of medical care only for older children, after potentially confounding variables were controlled for. Furthermore, this decreased use was found only for nonmental health specialty care visits. No reduction in primary care visits occurred. Other factors such as previous patterns of use and the presence of other morbidity were stronger predictors of subsequent primary health care use than was mental health treatment. Mental health treatment does not have a major impact on the high utilization of most children with psychosocial problems in pediatric settings. Because the reasons for this may be particular morbidity patterns in these children, future studies should include some measure of case mix as a potentially important variable in assessment of mental health treatment effects.

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