Grantee Publication

This article uses recent experiences from the Medigap market to draw conclusions about the advisability of alternative methods of regulating the market for long-term care insurance. The analysis is based in part on interviews of state insurance regulators, insurance companies, and interest-group representatives. The authors conclude that some regulation of the market is appropriate, but that the structure and extent of regulation found in the Medigap market would likely be inappropriate for the long-term care insurance market at this time.

OBJECTIVE: To explore the response rate benefits and data limitations of mixing telephone and web survey modes in a health-related research study. DATA SOURCES/STUDY SETTING: We conducted a survey of salaried employees from one large employer in the manufacturing sector in the summer of 2005. STUDY DESIGN: We randomized 751 subjects, all of whom had previously completed a web survey, to complete a health-related survey either by telephone (with web follow-up for nonrespondents) or over the web (with telephone follow-up).

Medicare, the federal health insurance program that covers some forty million elderly and disabled Americans, has grown rapidly since its inception in 1965. Medicare spending increased from $33.9 billion in 1980 (1.3% of GDP) to $252 billion in 2002 (2.5%). Spending growth has been driven in part by inflation and the aging of the Medicare population (older beneficiaries spend more than younger ones) but mostly by the incorporation of new and sometimes expensive medical technologies.

BACKGROUND: Racial and ethnic disparities in health care have been well documented, but poorly explained. OBJECTIVE: To examine the effect of access barriers, including English fluency, on racial and ethnic disparities in health care. RESEARCH DESIGN: Cross-sectional analysis of the Community Tracking Survey (1996-1997). SUBJECTS: Adults 18 to 64 years with private or Medicaid health insurance. MEASURES: Independent variables included race, ethnicity, and English fluency.

OBJECTIVES: This study sought to describe the evolution, use, and user satisfaction of a patient Web site providing a shared medical record between patients and health professionals at Group Health Cooperative, a mixed-model health care financing and delivery organization based in Seattle, Washington. DESIGN: This study used a retrospective, serial, cross-sectional study from September 2002 through December 2005 and a mailed satisfaction survey of a random sampling of 2,002 patients.

This paper analyzes the evolution of capital investment strategy at Catholic Healthcare West (CHW) between 1996 and 2005, as the forty-hospital system reversed its financial losses and diversified into ambulatory services and high-growth markets. The system developed a formal process for allocating capital among profitable facilities and those providing charitable services in communities with high social needs.

For over twenty-five years, Medicare has tried to promulgate a rule to implement the broad congressional directive to pay only for items and services that are "reasonable and necessary." A rule would clarify legal authority and describe specific criteria for evaluation of new technology in Medicare. This case study is an intractable example of a larger issue of regula mortis or dead rule. Regula mortis occurs when a mobilized interest group blocks legitimate administrative agency action, causing a regulatory stalemate.

After the 9/11 terrorist attacks, interest in the state of America’s public health system spiked, especially related to emergency preparedness. Significant new federal funding flowed to state and local agencies to bolster public health activities. But the spotlight on shoring up the nation’s public health system has faded, and the public appears unaware of escalating threats to such basic services as disease surveillance.

Many employers access and finance health coverage through a multiple employer arrangement (MEWA).  However, in the past 30 years, such arrangements have had a troubled history, with financial instability.  Since 2000, four MEWAs have become insolvent, leaving 66,000 people without health insurance and with an estimated $48 million in medical claims.  In some cases, multiple employer arrangements have either been victims of fraud or were established for fraudulent purposes by unscrupulous individulas.  Most recently between 2000 and 2002, 144 illegal entities selling cove

This paper reviews recent empirical evidence on the effects of hospital ownership conversions on quality of care and provision of public goods, such as uncompensated care, and presents new results on these topics based on hospital discharge data from the Healthcare Cost and Utilization Project’s (HCUP) Nationwide Inpatient Sample. My analysis of these data reveals that conversion from government or private nonprofit to for-profit ownership has no effect on in-hospital mortality, but rates of pneumonia complications increased following conversion to for-profit status.