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Author Interviews, Cost of Health Care, Education, Johns Hopkins, Primary Care / 15.06.2015

MedicalResearch.com Interview with: Eric T. Roberts and Darrell Gaskin Johns Hopkins University Bloomberg School of Public Health Baltimore, MD Medical Research: What is the background for this study? What are the main findings? Response: This study looked at the implications of the Affordable Care Act’s expansion of Medicaid on the need for additional physicians working in primary care. Since 2014, 11 million low-income adults have signed up for Medicaid, and this figure will likely increase as more states participate in the expansion. Many new Medicaid enrollees lacked comprehensive health insurance before, and will be in need of primary and preventive care when their Medicaid coverage begins. In light of these questions, in this study, we projected the number of primary care providers that are needed to provide care for newly-enrolled adults. We forecast that, if all states expand Medicaid, newly-enrolled adults will make 6.1 million additional provider visits per year. This translates into a need for 2,100 additional full time-equivalent primary care providers. We conclude that this need for additional providers is manageable, particularly if Congress fully funds key primary care workforce training programs, such as the National Health Service Corps. (more…)
Author Interviews, Cost of Health Care, University of Pittsburgh / 03.06.2015

Julie M. Donohue, Ph.D. Associate professor and Vice Chair for Research Graduate School of Public Health Department of Health Policy and Management University of PittsburghMedicalResearch.com Interview with: Julie M. Donohue, Ph.D. Associate professor and Vice Chair for Research Graduate School of Public Health Department of Health Policy and Management University of Pittsburgh Medical Research: What is the background for this study? What are the main findings? Dr. Donohue: We looked at data on medication use from January through September 2014 on 1 million Affordable Care Act-established marketplace insurance plan enrollees. Our analysis found that among people who enrolled in individual marketplaces, those who enrolled earlier were older and used more medication than later enrollees. Marketplace enrollees, as a whole, had lower average drug spending per person and were less likely to use most medication classes than patients enrolled in employer-sponsored health insurance. However, marketplace enrollees were much more likely to use medicines for hepatitis C and for HIV, which is particularly important given the general concerns about the rising costs of these medications for consumers. (more…)
Author Interviews, Cost of Health Care, Emergency Care / 16.03.2015

MedicalResearch.com Interview with: Asako Moriya Ph.D School of Public and Environmental Affairs Indiana University, Bloomington, IN Center for Financing, Access and Cost Trends Agency for Healthcare Research and Quality Rockville, MD MedicalResearch: What is the background for this study? What are the main findings? Response: Historically, young adults have had the lowest rate of insurance coverage.  They have also frequently sought non-urgent care in emergency departments (EDs). However, ED care, while appropriate for injuries and other true emergencies, is very expensive and inefficient for non-urgent care. The Affordable Care Act (ACA)’s dependent coverage provision requires health plans that offer dependent coverage to allow young adults to stay on their parents’ private health plans until age 26. This insurance expansion had a potential to improve efficiency by reducing inappropriate ED use. We used data from the Agency for Healthcare Research and Quality and found that the quarterly ED-visit rate decreased by a small, but statistically significant amount (1.6 per 1,000 population) among adults age 19-25 after the implementation of the ACA’s dependent coverage provision. The decrease was concentrated among women, weekday visits, non-urgent conditions, and conditions that could be treated in other settings. We found no effect among visits due to injury, weekend visits, and urgent conditions. The findings suggest that the ACA’s dependent coverage provision has increased the efficiency of medical care delivery by reducing non-urgent ED use. Having access to their parents’ health insurance appears to be prompting young adults to use medical care more appropriately. (more…)
Author Interviews, Cost of Health Care, Education / 13.03.2015

MedicalResearch.com Interview with: Tyler Winkelman, M.D. Internal Medicine and Pediatrics - PGY 4 University of Minnesota MedicalResearch: What is the background for this study? What are the main findings? Dr. Winkelman: Future physicians will practice after key provisions of the Affordable Care Act (ACA) have been enacted.  Whether medical students support or understand the legislation or are willing to engage in its implementation or modification as part of their professional obligation is unknown.  We surveyed medical students at 8 U.S. medical schools to assess their views and knowledge of the ACA (RR=52%).  We found that the majority of students support the ACA and indicate a professional obligation to assist with its implementation. There are, however, gaps in knowledge with regards to Medicaid expansion and insurance plans available within the health exchanges.  Students anticipating a surgical or procedural specialty, compared to those anticipating a medical specialty, were less likely to support the ACA, less likely to indicate a professional obligation to implement the ACA, and more likely to have negative expectation of the ACA.  Moderates, liberals, and those with above average knowledge scores were more likely to support the ACA and indicate a professional obligation to assist with its implementation. (more…)
AHRQ, Author Interviews / 07.02.2015

Steven C. Hill, PhD Center for Financing, Access and Cost Trends Agency for Healthcare Research and Quality Rockville, MD 2085MedicalResearch.com Interview with: Steven C. Hill, PhD Center for Financing, Access and Cost Trends Agency for Healthcare Research and Quality Rockville, MD 20850 MedicalResearch: What is the background for this study? Dr. Hill: The Affordable Care Act offers two major ways to extend health coverage to more Americans: through expanding state Medicaid programs and through the Marketplace. States can expand Medicaid coverage to adults with family incomes at or below 138 percent of the federal poverty guidelines (approximately $16,242 for an individual and $33,465 for a family of four in 2015). At the time of the study, 23 states had not yet expanded their Medicaid programs. In those states, poor adults typically continue to have very limited access to Medicaid. However, adults with incomes at or above the poverty guidelines who lack access to affordable insurance elsewhere are eligible for premium tax credits in the Marketplace. If these low-income adults purchase silver plans, then they are also generally eligible for cost sharing reductions. MedicalResearch: What was the methodology for study? Dr. Hill: The study used data from then Agency for Healthcare Research and Quality’s Medical Expenditure Panel Survey (MEPS) to determine family out-of-pocket health care spending in 2005 – 2010 for uninsured, low-income adults who lived in the states that had not yet expanded Medicaid under the Affordable Care Act at the time of the study. The study focused on those who would have been eligible for Medicaid if their states expanded eligibility (income at or below 138 percent of poverty guideline), and whose incomes were high enough to be eligible for premium tax credits and cost sharing reductions through the Health Insurance Marketplace (at or above poverty guidelines). The study then compared those data with the following simulated scenarios for these adults: coverage in a Marketplace silver plan with financial assistance; and enrolling in expanded Medicaid. (more…)
Author Interviews, Cancer Research, Cost of Health Care, Journal Clinical Oncology / 09.06.2014

Ayal A. Aizer, MD, MHS Harvard Radiation Oncology Program Boston, MAMedicalResearch Interview with: Ayal A. Aizer, MD, MHS Harvard Radiation Oncology Program Boston, MA MedicalResearch: What are the main findings of the study? Dr. Aizer: We studied Americans between the ages of 20-40 using the SEER Database (a national cancer registry) and found that patients who had insurance were more likely to present with localized (curable) versus metastatic (generally incurable) cancer. Patients with localized tumors were more likely to receive the appropriate treatment and, most importantly, survived longer than patients without insurance. Our analysis accounted for demographic and socioeconomic differences between patients who were insured versus uninsured. Our results indicate that insurance status is a powerful predictor of outcome among young adults with cancer. The Affordable Care Act, which will likely improve insurance coverage nationally, may yield improved cancer outcomes among Americans. (more…)
Asthma, Author Interviews, Cost of Health Care / 21.05.2014

dr_vicki_fung MedicalResearch.com Interview with: Vicki Fung, Ph.D. Assistant Professor Department of Medicine, Harvard Medical School Mongan Institute for Health Policy, Massachusetts General Hospital   MedicalResearch: What are the main findings of the study? Dr. Fung: We found that lower income parents of children with asthma were more likely to delay or avoid taking their children to a doctor's office visit or to the emergency room if they had to pay higher out-of-pocket costs for care; they were also more likely to report borrowing money to pay for asthma care. (more…)
Author Interviews, Cost of Health Care, Emergency Care / 06.11.2013

MedicalResearch.com Interview with: Jessica E. Galarraga, MD, MPH Resident Physician Department of Emergency Medicine George Washington University Hospital 2120 L. St. N.W. Suite 475 Washington D.C. Jessica E. Galarraga, MD, MPH Resident Physician Department of Emergency Medicine George Washington University Hospital 2120 L. St. N.W. Suite 475 Washington D.C.   MedicalResearch.com: What are the main findings of the study? Dr. Galarraga: This study examined how emergency department (ED) reimbursements for outpatient visits may be impacted by the insurance coverage expansion of the Patient Protection and Affordable Care Act as newly eligible patients gain coverage either through the Medicaid expansion or through health insurance exchanges. We conducted our analyses using the Medical Expenditure Panel Survey, a nationally representative survey managed by the Agency for Healthcare Research and Quality. We found that ED reimbursements for outpatient encounters by the previously uninsured who gain Medicaid insurance may increase by  17 percent and moving Medicaid-expansion ineligible patients to the private insurance market through insurance exchanges may increase reimbursements as high as 39 percent after the act is implemented. (more…)
Cost of Health Care, JAMA / 28.06.2013

Genevieve Kenney Ph.D Senior Fellow and Co-Director, Health Policy Center The Urban Institute 2100 M Street NW Washington DC 20037MedicalResearch.com  Interview with Genevieve Kenney Ph.D Senior Fellow and Co-Director, Health Policy Center The Urban Institute 2100 M Street NW Washington DC 20037 MedicalResearch.com: What are the main findings of the study? Dr. Kenney: Our study is the first published analysis that draws on physical examinations, laboratory tests, and patient reports to assess the health needs and health risks of uninsured adults who could be eligible for Medicaid coverage under the Affordable Care Act relative to the adults who are already enrolled in Medicaid. Our main findings are that the uninsured adults who could enroll under the ACA are less likely than the adults with Medicaid coverage to be obese and to have functional limitations and chronic health problems, such as hypertension, hypercholesterolemia, or diabetes, but that the uninsured adults with these chronic conditions are less likely to be aware that they have them and less likely to have the condition under control. In comparison to the Medicaid population, the uninsured adults in our study were also less likely to have seen a health professional in the prior year and to have a routine place for care.  The rates of undiagnosed and uncontrolled chronic health care problems found in our study indicate that millions of low-income uninsured adults are currently at risk of premature mortality and other significant health issues.  These findings provide new evidence of the potential health benefits associated with the Medicaid expansion under the Affordable Care Act. (more…)