Reducing Medical Spending of the Publicly Insured: The Case for a Cash-Out Option

Individuals’ medical spending has both necessary and discretionary components, which are not, however, separately observable. This paper studies ways to improve upon existing public health insurance policies by using a framework where both the discretionary and necessary components of medical spending are explicitly modeled. First, using a simple theoretical framework, the paper shows that the key to reducing discretionary medical spending is to introduce a trade-off between nonmedical and medical consumption. Next, using a rich quantitative life-cycle model, the paper shows that this trade-off can be successfully implemented by introducing an option to substitute public health insurance with cash transfers. (JEL D91, G22, H51, I13, I18, I38)

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Anesthesia Care Team Composition and Surgical Outcomes

Anesthesiology ◽

10.1097/aln.0000000000002275 ◽

2018 ◽

Vol 129 (4) ◽

pp. 700-709 ◽

Cited By ~ 9

Author(s):

Eric C. Sun ◽

Thomas R. Miller ◽

Jasmin Moshfegh ◽

Laurence C. Baker

Keyword(s):

Length Of Stay ◽

The United States ◽

Nurse Anesthetists ◽

Care Team ◽

Perioperative Outcomes ◽

Anesthesia Care ◽

Team Composition ◽

Nurse Anesthetist ◽

Medical Spending ◽

Publicly Insured

Abstract Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background In the United States, anesthesia care can be provided by an anesthesia care team consisting of nonphysician providers (nurse anesthetists and anesthesiologist assistants) working under the supervision of a physician anesthesiologist. Nurse anesthetists may practice nationwide, whereas anesthesiologist assistants are restricted to 16 states. To inform policies concerning the expanded use of anesthesiologist assistants, the authors examined whether the specific anesthesia care team composition (physician anesthesiologist plus nurse anesthetist or anesthesiologist assistant) was associated with differences in perioperative outcomes. Methods A retrospective analysis was performed of national claims data for 443,098 publicly insured elderly (ages 65 to 89 yr) patients who underwent inpatient surgery between January 1, 2004, and December 31, 2011. The differences in inpatient mortality, spending, and length of stay between cases where an anesthesiologist supervised an anesthesiologist assistant compared to cases where an anesthesiologist supervised a nurse anesthetist were estimated. The approach used a quasirandomization technique known as instrumental variables to reduce confounding. Results The adjusted mortality for care teams with anesthesiologist assistants was 1.6% (95% CI, 1.4 to 1.8) versus 1.7% for care teams with nurse anesthetists (95% CI, 1.7 to 1.7; difference −0.08; 95% CI, −0.3 to 0.1; P = 0.47). Compared to care teams with nurse anesthetists, care teams with anesthesiologist assistants were associated with non–statistically significant decreases in length of stay (−0.009 days; 95% CI, −0.1 to 0.1; P = 0.89) and medical spending (−$56; 95% CI, −334 to 223; P = 0.70). Conclusions The specific composition of the anesthesia care team was not associated with any significant differences in mortality, length of stay, or inpatient spending.

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Voter Registration Among People With HIV in North Carolina

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab037 ◽

2021 ◽

Vol 8 (2) ◽

Author(s):

Asher J Schranz ◽

Nadya Belenky ◽

Haley A Moss ◽

Sonia Napravnik ◽

David L Rosen

Keyword(s):

North Carolina ◽

Health Status ◽

Vulnerable Population ◽

Voter Registration ◽

Public Resources ◽

Publicly Insured

Abstract Persons with HIV (PWH) represent a socially and medically vulnerable population who often depend on public resources. We examined voter registration among PWH in North Carolina. Sixty-four percent were registered to vote. Registration was lower among PWH who were young, Hispanic, publicly insured or uninsured, and who had poor HIV health status.

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Prenatal Provider Breastfeeding Toolkit: Results of a Pilot to Increase Women’s Prenatal Breastfeeding Support, Intentions, and Outcomes

Journal of Human Lactation ◽

10.1177/08903344211008797 ◽

2021 ◽

pp. 089033442110087

Author(s):

Casey Rosen-Carole ◽

Jill Halterman ◽

Constance D. Baldwin ◽

Hayley Martin ◽

Nicolas P. N. Goldstein ◽

...

Keyword(s):

New York ◽

Breastfeeding Initiation ◽

Provider Education ◽

Breastfeeding Support ◽

Post Intervention ◽

Peer Counselors ◽

Breastfeeding Intention ◽

Healthy People 2020 ◽

Peer Counselor ◽

Publicly Insured

Background Breastfeeding rates for United States women with lower incomes fall below the government’s Healthy People 2020 Goals. Breastfeeding recommendations combined with support from providers and peer counselors help women decide to begin and sustain breastfeeding, but peer counselor uptake is low. Research Aim To evaluate changes in referrals to Women, Infants, and Children’s Supplemental Nutrition Program peer counselors, reported prenatal provider education and support, and breastfeeding outcomes (intention, initiation, 1-month duration of any and exclusive breastfeeding) after a prenatal breastfeeding promotion intervention. Method In this pre-post intervention study (2015–2016; upstate New York), providers implemented a Toolkit to discuss infant feeding recommendations and initiate peer counselor referral. We surveyed women pre- and post-implementation (after delivery; 1 month postpartum) about prenatal breastfeeding intentions, provider support, and breastfeeding outcomes. Analyses controlled for secular trends. Results Pre-intervention ( n = 71) and post-intervention ( n = 70) participants were 49% Black, 61% publicly insured, and 16% uninsured. More post-intervention participants had > 1 Toolkit use (76%), peer counselor program referrals (60.0% post vs. 36.6% pre, p < .01), reported any breastfeeding intention (89% vs. 72%, p = .013), and intended to breastfeed for > 1 year (31% vs. 14%, p = .014). Post-intervention breastfeeding initiation and exclusivity were higher, but not significantly different. Post-intervention participants reported better prenatal breastfeeding support. Conclusions Implementing a prenatal Breastfeeding Toolkit, including facilitating peer counselor referral, was associated with increases in provider counseling, participants’ breastfeeding intentions, and uptake of peer counselors. Replicating this approach may reinforce efforts to support breastfeeding in similar practices serving women with lower incomes.

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Who Enrolls In A Program For Parents Of Publicly Insured Children?

Health Affairs ◽

10.1377/hlthaff.w3.460 ◽

2003 ◽

Vol 22 (Suppl1) ◽

pp. W3-460-W3-471 ◽

Cited By ~ 1

Author(s):

Erin Fries Taylor ◽

Jeffrey T. Kullgren ◽

Catherine G. McLaughlin

Keyword(s):

Publicly Insured

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AGE AND MEDICAL SPENDING

PEDIATRICS ◽

10.1542/peds.84.6.1096 ◽

1989 ◽

Vol 84 (6) ◽

pp. 1096-1096

Keyword(s):

Health Care ◽

Health Care Spending ◽

Medical Spending ◽

Business Week

On average, 85% of an individual's health care expenses are in the last two years of life, reports Business Week magazine, adding that the 11% of the population older than 65 years of age now accounts for 35% of the nation's health care spending. By the year 2040, Americans older than 65 will account for 20% of the population.

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Quantifying Differences in Health Care Consumption for the Management of Multiple Sclerosis Within Privately and Publicly Insured Health Care Programs

Journal of Managed Care & Specialty Pharmacy ◽

10.18553/jmcp.2016.22.12.1385 ◽

2016 ◽

Vol 22 (12) ◽

pp. 1385-1391 ◽

Cited By ~ 4

Author(s):

Terrie Livingston ◽

Monica Fay ◽

Ravi Iyer ◽

Wendy Wells ◽

Michael W. Pill

Keyword(s):

Multiple Sclerosis ◽

Health Care ◽

Health Care Consumption ◽

Publicly Insured

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Why Parents Use the Emergency Department Despite Having a Medical Home

Clinical Pediatrics ◽

10.1177/0009922818809447 ◽

2018 ◽

Vol 58 (1) ◽

pp. 95-99 ◽

Cited By ~ 4

Author(s):

Kalpana Pethe ◽

Allison Baxterbeck ◽

Susan L. Rosenthal ◽

Melissa S. Stockwell

Keyword(s):

Emergency Department ◽

Low Income ◽

Medical Home ◽

Medical Problem ◽

Community Based ◽

Phone Line ◽

Medical Homes ◽

Medical Home Model ◽

After Hours ◽

Publicly Insured

Despite having a medical home, pediatric patients continue emergency department (ED) utilization for various reasons. This study examines parental reasons associated with the decision to seek ED care in a group of low-income, inner-city, publicly insured children. Surveys were conducted with parents of children (age = 0-19 years) presenting to a community-based clinic, which has an established medical home model with enhanced access. Most patients (88.3%) had a pediatrician, and nearly all (93.3%) reported a visit to the ED; most (75.7%) were aware of clinic walk-in hours, but less than half (42.6%) were aware of an after-hours phone line. There was no difference in those who were aware of walk-in hours or an after-hours phone line and a reported ED visit. Half of the parents (52.5%) thought their child’s medical problem was serious. In addition to providing enhanced efforts, medical homes should strive to make families aware of increased access.

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Medical Spending for the 2001 Anthrax Letter Attacks

Disaster Medicine and Public Health Preparedness ◽

10.1017/dmp.2018.113 ◽

2018 ◽

Vol 13 (03) ◽

pp. 539-546 ◽

Cited By ~ 2

Author(s):

Nicholas A. Zacchia ◽

Ketra Schmitt

Keyword(s):

Public Health ◽

Prophylactic Treatment ◽

Economic Impacts ◽

Cost Model ◽

Medical Costs ◽

Cost Data ◽

Public Health Preparedness ◽

News Reports ◽

Medical Spending ◽

The Us

ABSTRACTIntroductionThis paper assesses the total medical costs associated with the US anthrax letter attacks of 2001. This information can be used to inform policies, which may help mitigate the potential economic impacts of similar bioterrorist attacks.MethodsJournal publications and news reports were reviewed to establish the number of people who were exposed, were potentially exposed, received prophylactics, and became ill. Where available, cost data from the anthrax letter attacks were used. Where data were unavailable, high, low, and best cost estimates were developed from the broader literature to create a cost model and establish economic impacts.ResultsMedical spending totaled approximately $177 million.ConclusionsThe largest expenditures stemmed from self-initiated prophylaxis (worried well): people who sought prophylactic treatment without any indication that they had been exposed to anthrax letters. This highlights an area of focus for mitigating the economic impacts of future disasters. (Disaster Med Public Health Preparedness. 2019;13:539-546)

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