Despite More Insurance, Medicaid Recipients Still Use ER Over Primary Care

MedicalResearch.comInterview with:
Lisa M. Lines, PhD, MPH
University ofMassachusetts Medical School
Worcester
RTI International,Waltham, MA

MedicalResearch.com:  What is the background for this study?  What are the main findings?

Response: The problem of potentially avoidable emergency department (ED) visits has been linked to barriers in access to high-quality, timely primary care. In Massachusetts ,about half of all ED visits were considered potentially avoidable, or primary-care sensitive (PCS), in the mid-2000s. Indeed, improving access to primary care was a prime motive for the state’s – and the nation’s – first universal coverage health insurance program in 2006. Now, the state has the highest coverage rate in the country.

We used Massachusetts All-Payer Claims Data to study characteristics of insured Massachusetts residents associated with primary-care sensitive ED use and compared such use among people under age 65 with public (Medicaid[MassHealth]) versus private insurance. We studied more than 2.2 million individuals in 2011-12; about 40% had public insurance in 2011, and the rest had private insurance. Our PCS ED measure included nonurgent, urgent but primary care treatable, and urgent but potentially avoidable ED visits.

We found that primary-care sensitive ED use was more than 4 times higher among the publicly insured (public insurees: 36.5 PCS ED visits per 100 person-years; private insurees: 9.0). After adjusting for a range of potential confounders, such as the vastly different morbidity burden of the two groups, public insurance in2011 was associated with about 150% more primary-care sensitive ED use. We also found that 70% of people with public insurance had at least 1 primary care visit, compared with 80% of those with private insurance. The public group also had fewer visits to their PCP of record, even though nearly all of them had an officially designated PCP.

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Poor Health Insurance Literacy Linked to Avoidance of Health Care Services

MedicalResearch.com Interview with:
Renuka Tipirneni, MD, MSc Assistant Professor Holder of the Grace H. Elta MD Department of Internal Medicine Early Career Endowment Award 2019-2024 University of Michigan Department of Internal Medicine, Divisions of General Medicine and Hospital Medicine, and Institute for Healthcare Policy & Innovation Ann Arbor, MI 48109Renuka Tipirneni, MD, MSc
Assistant Professor
Holder of the Grace H. Elta MD Department of Internal Medicine Early Career Endowment Award 2019-2024
University of Michigan Department of Internal Medicine
Divisions of General Medicine and Hospital Medicine, and
Institute for Healthcare Policy & Innovation
Ann Arbor, MI 48109

MedicalResearch.com: What is the background for this study? What are the main findings?

Response:  Navigating health insurance and health care choices is challenging and requires significant health insurance literacy (knowledge and application of health insurance concepts). We looked at the association between U.S. adults’ health insurance literacy and avoidance of health care services due to perceived cost.

We found that 30% of people we surveyed reported delayed or foregone care because of perceived cost, and that those with lower health insurance literacy reported significantly greater avoidance of both preventive and nonpreventive health care services.

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High Deductible Plans Hit Chronically Ill Low-Income Patients Hardest

MedicalResearch.com Interview with:

Salam Abdus, PhD Division of Research and Modeling, Center for Financing, Access, and Cost Trends, Agency for Healthcare Research and Quality Department of Health and Human Services Rockville, Maryland

Dr. Abdus

Salam Abdus, PhD
Division of Research and Modeling,
Center for Financing, Access, and Cost Trends,
Agency for Healthcare Research and Quality
Department of Health and Human Services
Rockville, Maryland

MedicalResearch.com: What is the background for this study? What are the main findings? 


Response:
High deductible health plans are more prevalent than ever.

Previous research showed that adults in low-income families or with chronic conditions are more likely to face high financial burdens when they are enrolled in high-deductible health plans, compared to adults in higher income families or healthier adults.

In this study we examined the financial burden of high-deductible health plans among adults who are both low income and chronically ill. We used AHRQ’s Medical Expenditure Panel Survey Household Component (MEPS-HC) data from 2011 to 2015 to study the prevalence of high out-of-pocket health care spending burden of high deductible health plans among adults enrolled in employer-sponsored insurance. We included family out-of-pocket spending on premiums and health care services.

We found that among adults who had family income below 250% of Federal Poverty Level (FPL), had multiple chronic conditions, and were enrolled in high-deductible health plans, almost half (46.9%) had financial family out-of-pocket health care burden exceeding 20 percent of family disposable income.

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Routine Mammography Screening Recommendations Do Not Apply To Women With History of Breast Cancer

MedicalResearch.com Interview with:

Lisa A Newman, MD Director of the Breast Oncology Program for the multi-hospital  Henry Ford  Health System

Dr. Newman

Lisa A Newman, MD
Director of the Breast Oncology Program for the multi-hospital
Henry Ford  Health System

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: In 2009 the United States Preventive Services Task Force published a guideline recommending that American women at average risk for breast cancer defer undergoing screening mammography until they reach the age of 50 years. Prior to this publication, women were widely-encouraged to initiate annual mammography at age 40 years. Women that have a history of breast cancer are automatically considered to be at increased risk for developing a new breast cancer, and so routine screening mammography guidelines do not apply to them. These women require annual mammography regardless of age, unless they have undergone a bilateral mastectomy.

We utilized data from Michigan Blue Cross/Blue Shield to evaluate patterns of mammography utilization among women age 40-49 years, comparing rates before versus after 2009, when the USPSTF guideline was published. We analyzed women that had a prior history of breast cancer separately from those that had no history of breast cancer, and we excluded women that underwent bilateral mastectomy.

Disturbingly, we found that mammography utilization rates declined among women with a history of breast cancer as well as among those with no history of breast cancer in the post-2009 timeline.

This suggested to us that changes in screening recommendations may have had the unintended consequence of generating confusion and misunderstandings regarding the value of mammography among women that undeniably benefit from this imaging, such as those with a history of breast cancer.  Continue reading

Decreased Cost-Sharing Increased Patient Adherence

MedicalResearch.com Interview with:

A. Mark Fendrick, M.D. Professor, Division of General Medicine, Department of Internal Medicine and Department of Health Management and Policy Director, University of Michigan Center for Value-Based Insurance Design Ann Arbor, Michigan 48109-2800

Dr. Fendrick

A. Mark Fendrick, M.D.
Professor, Division of General Medicine, Department of Internal Medicine and Department of Health Management and Policy
Director, University of Michigan Center for Value-Based Insurance Design
Ann Arbor, Michigan 48109-2800

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: As Americans are being asked to pay more for the medical care, in terms of copayments and deductibles, one in four Americans reports having difficulty paying for their prescription drugs. One potential solution is “value-based insurance design,” or V-BID. V-BID, is built on the principle of lowering or removing financial barriers to essential, high-value clinical services. V-BID plans align patients’ out-of-pocket costs, such as copayments and deductibles, with the value of services to the patient. They are designed with the tenet of “clinical nuance” in mind— in that the clinical benefit derived from a specific service depends on the consumer using it, as well as when, where, and by whom the service is provided.

According to a literature review published in the July 2018 issue of Health Affairs,  The researchers found that value-based insurance design programs which reduced consumer cost-sharing for clinically indicated medications resulted in increased adherence at no change in total spending. In other words, decreasing consumer cost-sharing meant better medication adherence for the same total cost to the insurer. Continue reading

More Stress Among LGB Adults Where Policies Permit Denial of Service to Same Sex Couples

MedicalResearch.com Interview with:

Julia Raifman, ScD SM Assistant Professor Health Law, Policy, and Management Boston University School of Public Health Boston, MA 02118

Dr. Raifman

Julia Raifman, ScD SM
Assistant Professor
Health Law, Policy, and Management
Boston University School of Public Health
Boston, MA 02118

MedicalResearch.com: What is the background for this study? What methods did you use? What are the main findings?

Response: The study was motivated by evidence that lesbian, gay, and bisexual (LGB) people in the United States have elevated levels of depression, anxiety, suicide, and mental distress. LGB mental health disparities have been linked to experiences of stigma based on sexual orientation, but most of this evidence comes from studies of association. We were interested in investigating how state policies permitting the denial of services to same-sex couples affected the mental health of LGB individuals.

We used data that are representative of all adults in each of the nine states included in the study, from the 2014 to 2016 waves of the Behavioral Risk Factor Surveillance System (BRFSS). The main outcome was mental distress, which can include stress, depression, and problems with emotions. We evaluated changes in mental distress among LGB adults in three states that passed policies permitting the denial of services to same-sex couples compared to changes in mental distress among heterosexual adults in the same states and among LGB adults in six control states. We controlled for all state characteristics that did not change over time, as well as individual age group, race, ethnicity,  sex, educational attainment, employment, income, and marital status.  Continue reading

Growing Insurance Coverage Did Not Reduce Access To Care For Those Already Insured

MedicalResearch.com Interview with:

Salam Abdus, Ph.D. Agency for Healthcare Research and Quality

Dr. Salam Abdus

Salam Abdus, Ph.D.
Agency for Healthcare Research and Quality

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: When the ACA was passed, some people were concerned that access to care for people who already had insurance would decrease because there would be so many newly insured people trying to get care.

To answer this question, we reviewed eight measures of access using data from the Agency for Healthcare Research and Quality’s Medical Expenditure Panel Survey (MEPS) and the Census Bureaus’ American Community Survey for the period 2008-2014 to study if change in local area insurance rate affected access to care of adults who were continuously insured for two years. Access measures that we looked at include whether they had a usual source of care, were unable to receive necessary medical care, were delayed in receiving necessary medical care, had a physical exam in the past year, had blood pressure checked, had a flu shot, experienced delays getting a doctor appointment, and problems seeing a specialist.

We found no consistent evidence of negative impacts on continuously insured adults. We also looked at two subgroups of vulnerable adults: Medicaid beneficiaries and adults living in health professional shortage areas. For both continuously insured subgroups we found no consistent evidence of negative impacts.

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Affordable Care Act Linked To Marked Increase in Surgery for Thyroid Cancer

MedicalResearch.com Interview with:

Benjamin James, MD MS Assistant Professor of Surgery Adjunct Assistant Professor of Otolaryngology Section of Endocrine Surgery IU Division of General Surgery Indiana University Hospital Indianapolis, IN 46202

Dr. Benjamin James

Benjamin James, MD MS
Assistant Professor of Surgery
Adjunct Assistant Professor of Otolaryngology
Section of Endocrine Surgery
IU Division of General Surgery
Indiana University Hospital
Indianapolis, IN 46202

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Over the few decades, there has been a substantial increase in the incidence of thyroid cancer. It is the fastest growing cancer and a recent study in JAMA found that the mortality rate has been rising.

In 2006, Massachusetts passed healthcare reform, which expanded Medicaid, created new subsidized insurance programs for those ineligible for Medicaid and extended young adults eligibility on parental plans until the age of 26.

The aim of our study was to evaluate the impact this has had on the treatment of thyroid cancer. To address this question, we used the Hospital Cost and Utilization Project State Inpatient Databases for Massachusetts, New Jersey, New York, and Florida, which included a cohort of 56,581 inpatient admissions from 2001 to 2011. We then compared these states before and after the healthcare reform in Massachusetts to evaluate the effect the healthcare reform had on the treatment of thyroid cancer.

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Primary Care Wait Times For Medicaid Patients Increased Modestly Under Affordable Care Act

MedicalResearch.com Interview with:

Molly Candon, PhD Fellow Leonard Davis Institute of Health Economics, The Wharton School Center for Mental Health Policy and Services Research, Perelman School of Medicine University of Pennsylvania

Dr. Molly Candon

Molly Candon, PhD
Fellow
Leonard Davis Institute of Health Economics, The Wharton School
Center for Mental Health Policy and Services Research, Perelman School of Medicine
University of Pennsylvania

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Primary care practices are less likely to schedule appointments with Medicaid patients compared to the privately insured, largely due to lower reimbursement rates for providers. Given the gap in access, concerns have been raised that Medicaid enrollees may struggle to translate their coverage into care. Despite the substantial increase in demand for care resulting from provisions in the Affordable Care Act (ACA), our 10-state audit study recently published in JAMA Internal Medicine finds that primary care appointment availability for new patients with Medicaid increased 5.4 percentage points between 2012 and 2016, while appointment availability for patients with private coverage did not change.

Over the same time period, both Medicaid patients and the privately insured experienced slight increases in wait times.

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When Patients Can’t Choose: Out-of-Network Care Can Be Costly

MedicalResearch.com Interview with:

Ge Bai, PhD, CPA Assistant Professor The Johns Hopkins Carey Business School Washington, DC 20036

Dr. Ge Bai

Ge Bai, PhD, CPA
Assistant Professor
The Johns Hopkins Carey Business School
Washington, DC 20036 

MedicalResearch.com: What is the background for this study? What are the main findings?
Response: The average anesthesiologist, emergency physician, pathologist and radiologist charge more than four times what Medicare pays for similar services, often leaving privately-insured out-of-network patients stuck with surprise medical bills that are much higher than they anticipated.

The average physician charged roughly 2.5 times what Medicare pays for the same service. There are also regional differences in excess charges. Doctors in Wisconsin, for example, have almost twice the markups of doctors in Michigan (3.8 vs. two).

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Prevent Cancer Foundation Tool Compares Screening Coverage By Major Health Insurers

MedicalResearch.com Interview with:

Carolyn R. Aldigé

Carolyn R. Aldigé

Carolyn R. Aldigé
President of the Prevent Cancer Foundation

MedicalResearch.com: What is the background for this tool? What types of cancers are covered under this comparison tool?

Response: The coverage tool compares screening coverage by the 30 largest health insurers in the U.S. Consumers can use the tool to see their insurance plans’ policies on coverage of screening tests for breast, cervical, colorectal, lung and prostate cancers.

MedicalResearch.com: What are some of the differences in insurance coverage of screening tests?

Response: There is a sizable variation in what insurance plans cover, partly a result of differing screening guidelines from three leading organizations. Though insurance plans are required to cover screenings recommended by the United States Preventive Services Task Force (USPSTF) without a co-pay, many will choose to cover other screening tests as well—but which guidelines do they follow? This is confusing to both patients and providers.

Breast cancer screening is an area where we see big differences in insurance coverage. All 30 plans cover 2D mammography, but only 13 plans cover 3D mammography (tomosynthesis).

Colorectal cancer screening coverage also differs. While almost all plans cover colonoscopy, CT colonography, flexible sigmoidoscopy, and FIT and FOBT screening tests, there are differences in coverage of stool-based DNA tests.

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Uninsured Kids More Likely To Be Transferred From Emergency Departments

MedicalResearch.com Interview with:

Yunru Huang Ph.D. Candidate in epidemiology Department of Pediatrics University of California Davis, Sacramento, CA

Yunru Huang and Dr. James Marcin (left)

Yunru Huang
Ph.D. Candidate in epidemiology
Department of Pediatrics
University of California
Davis, Sacramento, CA

MedicalResearch.com: What is the background for this study?

Response: Each year, more than 27 million children seek care in emergency departments (EDs) in the United States. Many EDs, however, are not fully equipped with the recommended pediatric supplies and may not have access to the pediatric specialists and resources needed to provide definitive care. As a result, many children receiving treatment in EDs of hospitals with limited pediatric resources are transferred to another hospital’s ED or inpatient unit for admission.

The Emergency Medical Treatment and Active Labor Act (EMTALA) requires hospitals to make decisions on patient transfer and admission independent of insurance status. That is, the decision to transfer a patient to another hospital for admission should only depend upon clinical factors or the need for specialty services. However, patterns observed in the medical literatures have suggested that a child’s insurance status could be associated with transfer and admission decisions. These studies have been limited to single institutions and/or have been limited to specific conditions._ENREF_14 Whether or not transfer decisions among pediatric patients are related to insurance status has yet to be studied on a national level and across a variety of diagnoses.

We used Healthcare Cost and Utilization Project 2012 Nationwide Emergency Department Sample data and sought to investigate the relationships between insurance status and odds of transfer relative to local admission among pediatric patients receiving care in the ED.

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Health Benefits of Insurance Coverage Under ACA Become More Apparent With Time

MedicalResearch.com Interview with:

Benjamin D. Sommers, MD, PhD Assistant Professor of Health Policy & Economics Harvard T. H. Chan School of Public Health / Brigham & Women's Hospital Boston, MA 02115

Dr. Benjamin D. Sommers

Benjamin D. Sommers, M.D., Ph.D
Assistant Professor of Health Policy & Economics Department of Health Policy & Management
Harvard T.H. Chan School of Public Health
Assistant Professor of Medicine Division of General Medicine & Primary Care
Brigham & Women’s Hospital / Harvard Medical School

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: More than half of states have expanded Medicaid under the Affordable Care Act, and several states have taken alternative approaches, such as using federal Medicaid funds to purchase private insurance for low-income adults. Our study looks at the effects of these two different approaches – vs. not expanding at all – in three southern states (Kentucky Arkansas, and Texas). What we find is that expanding coverage, whether by Medicaid (Kentucky) or private insurance (Arkansas), leads to significant improvements in access to care, preventive care, quality of care, and self-reported health for low-income adults compared to not expanding (Texas). The benefits of the coverage expansion also took a while to become evident – the first year of expansion (2014) showed some of these changes, but they become much more apparent in the second year (2015).

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Large Proportion of Pregnant Women Use Alcohol and Tobacco in First Trimester

MedicalResearch.com Interview with:

Dr. Qiana L. Brown, PhD, MPH, LCSW Postdoctoral Research Fellow Columbia University Mailman School of Public Health Department of Epidemiology Substance Abuse Epidemiology Training Progra

Dr. Qiana Brown

Dr. Qiana L. Brown, PhD, MPH, LCSW
Postdoctoral Research Fellow
Columbia University
Mailman School of Public Health
Department of Epidemiology
Substance Abuse Epidemiology Training Program

MedicalResearch.com: What is the background for this study?

Dr. Brown: Prenatal substance use is a major public health concern, and poses significant threats to maternal and child health. Tobacco and alcohol are the most commonly used substances among pregnant women and non-pregnant women of reproductive age, and are leading causes of preventable adverse health outcomes for both mother and baby. Women with health insurance have more prenatal visits, and present for prenatal care earlier than uninsured women, which may increase their exposure to health messaging around substance abuse prevention at prenatal visits. Additionally, treatment for substance use disorders and maternal and child health care are part of the Essential Health Benefits covered by the Affordable Care Act, which may encourage patients and providers to engage in discussions around alcohol and tobacco use prevention during pregnancy.

Given these factors, we examined the relationship between health insurance coverage and both past month tobacco use and past month alcohol use among a nationally representative sample of reproductive age women in the United States. We sampled 97,788 women ages 12 to 44 years old who participated in the U.S. National Survey of Drug Use and Health in 2010 to 2014. Among these women, 3.28% (n=3,267) were pregnant. We specifically investigated whether the relationship between health insurance and alcohol or tobacco use differed between pregnant and non-pregnant women.
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Gap in Public-Private Insurance Payments Contines to Widen

MedicalResearch.com Interview with:
Thomas Selden, Ph.D.

Director of the Division of Research and Modeling
Center for Financing, Access, and Cost Trends
Agency for Healthcare Research and Quality (AHRQ), in Rockville, Maryland. 

Medical Research: What is the background for this study? What are the main findings?

Dr. Selden: Spending on hospital care is expected to exceed $1 trillion for the first time in 2015, and it is important to understand the differences between public and private payment rates if we want to achieve the goals of better care, smarter spending, and healthier people – the triple aims found in HHS’ National Quality Strategy.  Our study examined data on inpatient hospital stays between 1996 and 2012, finding that payments to hospitals from private insurers in 2012 were 75 percent greater than Medicare’s – a sharp increase from the approximate 10 percent difference between 1996 and 2001. 

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Hispanics Most Likely To Lack Medical Insurance

MedicalResearch.com Interview with:
Jeffrey Rhoades, Ph.D.
Agency for Healthcare Research and Quality

Medical Research: What is the background for this study?

Dr. Rhoades: The Medical Expenditure Panel Survey (MEPS) – Household Component (HC) which began in 1996 and is administered annually collects data from a sample of families and individuals in selected communities across the United States, drawn from a nationally representative subsample of households that participated in the prior year’s National Health Interview Survey (conducted by the National Center for Health Statistics).

During the household interviews, MEPS collects detailed information for each person in the household on the following: demographic characteristics, health conditions, health status, use of medical services, charges and source of payments, access to care, satisfaction with care, health insurance coverage, income, and employment.

The panel design of the survey, which features several rounds of interviewing covering two full calendar years, makes it possible to determine how changes in respondents’ health status, income, employment, eligibility for public and private insurance coverage, use of services, and payment for care are related.

Medical Research: What are the main findings?

Dr. Rhoades: In 2013, Hispanics were more likely to be uninsured for the entire year or sometime during the year than other racial/ethnic groups.

In 2013, persons living in the South and West regions were more likely to be uninsured for the entire year or sometime during the year than people living in the Northeast or Midwest.

Approximately 50 percent of individuals with the lowest hourly wage (less than $10 per hour) were uninsured sometime during the year in 2013. This fraction decreased with increasing wages.

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Patients With Health Insurance Receive Up To Triple Amount Of Preventive Care

Jared Fox, PhD CDC Office of the Associate Director for PolicyMedicalResearch.com Interview with:
Jared Fox, PhD
CDC Office of the Associate Director for Policy

Medical Research: What is the background for this study? What are the main findings?

Dr. Fox:  Increasing the number of people who get preventive care is important to keep people healthier, avoid complications from illnesses, reduce long-term health care costs, and prevent premature deaths. By one estimate, over 100,000 lives could be saved each year if more people got their recommended preventive care.

By providing access to affordable insurance coverage and eliminating out-of-pocket costs for recommended preventive care in most health plans, the Affordable Care Act has reduced cost as a barrier to preventive care. This report could serve as a baseline for tracking the effects of some of the ACA’s preventive care provisions that might occur after 2012.

The services in this study are recommended by the US Preventive Services Task Force and the Advisory Committee for Immunization Practices. The nine preventive services that were part of this study were:  screenings for blood pressure, breast cancer, cervical cancer, cholesterol, colon cancer, and diabetes; healthy diet counseling; and vaccination for hepatitis A and B. The data is from the 2011 and 2012 National Health Interview Survey.

In 2011 and 2012, people with health insurance received needed preventive care at up to three times the rate of those without insurance. People with higher household incomes also got more recommended preventive care than those with lower incomes.

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Study shows families could save more than $1,000 on average if states expanded Medicaid.

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.

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Insurance Status May Predict Cancer Outcome in Young Adults

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.

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Number of Low Income Uninsured Higher In States Not Expanding Medicaid

dr_sandra_l_deckerMedicalResearch.com Interview
Sandra L. Decker, Ph.D.
Distinguished Consultant
Centers for Disease Control and Prevention
National Center for Health Statistics
Hyattsville, MD 20782

 

MedicalResearch.com: What are the main findings of the study?

Dr. Decker: One of the main findings is that the percent of the low income population that is uninsured is higher in states not expanding Medicaid than those expanding.  The low income uninsured in non-expansion states are more likely to report having or having had certain health conditions such as hypertension, cancer, stroke, emphysema, or a heart condition than those in expansion states.  Continue reading

Expanded Health Insurance: Hospital Services Use by Young Adults with Behavioral Diagnoses

MedicalResearch.com Interview with:
Ellen R. Meara Associate Professor of The Dartmouth Institute Adjunct Associate Professor in Economics & Nelson A. Rockefeller Center for Public Policy, Dartmouth College Ellen R. Meara
Associate Professor of The Dartmouth Institute
Adjunct Associate Professor in Economics & Nelson A. Rockefeller Center for Public Policy, Dartmouth College


MedicalResearch.com: What are the main findings of this study?

Answer: When insurance coverage for young adults rose by over 15 percentage points following Massachusetts’ 2006 health reform, use of inpatient care for mental illness and substance use disorders fell and emergency department visits for these conditions grew more slowly for 19 to 25 year olds in Massachusetts relative to other states. Also, their care was much more likely to be paid for by private or public insurance insurers.

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Children’s Health Insurance Program: Expansion did not reduce ER Use

Adrianne Haggins, MD, MS University of Michigan Health System Department of Emergency Medicine Ann Arbor, MI  48109-5303MedicalResearch.com Interview with:
Adrianne Haggins, MD, MS
University of Michigan Health System
Department of Emergency Medicine
Ann Arbor, MI  48109-5303


MedicalResearch.com: What are the main findings of the study?

Dr. Haggins: Since the implementation of the Children’s Health Insurance Program (CHIP) in 1997, the last national health care reform that broadly expanded insurance coverage, adolescent use of primary care and specialty care has increased substantially in comparison to no change seen among the comparison group (young adults, who were not covered).  Broadening insurance coverage for adolescents did not result in a decrease in emergency department use, while ED use in the comparison group increased over time.   Continue reading