Grantee Publication

Background: Palliative care is increasingly viewed as a care option that should not only be offered to patients very near the end of life. An important question is whether increased use of palliative care soon after a patient's referral will improve patient functioning, an aspect of quality of life. Objectives: The aim of this study was to determine if increased use of palliative care is associated with increased patient functioning.

The inappropriate use of emergency departments (EDs) and ambulatory care sensitive hospital admission rates by patients attributed to a national sample of 212 medical group practices is documented, and the characteristics of practices that influence these rates are identified. Hospital-owned practices have higher nonemergent and emergent primary care treatable ED rates and higher ambulatory care sensitive hospitalization rates. Practices with electronic health records have lower inappropriate ED rates but those in rural areas have significantly higher rates.

The Affordable Care Act permanently slows the growth in Medicare hospital prices. To better understand the effects of those price cuts, we used data from ten states for the period 1995–2009 to examine the market-level relationship between Medicare prices and hospital utilization among the elderly. Regression analyses indicate that a 10 percent reduction in the Medicare price was associated with a 4.6 percent reduction in discharges among the elderly. This volume response to price cuts appears to be accomplished through hospitals’ reduction in their numbers of staffed beds.

Provisions within the Affordable Care Act, including the introduction of subsidized, Exchange-based coverage for lower income Americans lacking access to employer coverage, are expected to greatly expand the size and importance of the individual market. Using multiple federal surveys and administrative data from the National Association of Insurance Commissioners, we generate national-, regional-, and state-level estimates of the individual market.

Anecdotal reports suggest that substantial variation exists in private insurers’ payments for physician services, but systematic evidence is lacking. Using a retrospective analysis of insurance claims for routine office visits, consultations, and preventive visits from more than forty million physician claims in 2007, we examined variations in private payments to physicians and the extent to which variation is explained by patients’ and physicians’ characteristics and by geographic region.

Smoking during pregnancy can have significant adverse health effects for babies, yet many women smoke during pregnancy. In this paper, we examine whether state tobacco control policies lead to improved birth outcomes and to what extent the success of these policies depends on accumulated maternal human capital.We use data from the Pregnancy Risk Assessment Monitoring System in a time period when states significantly changed their tobacco control policies. Results show that the smoking policies are limited in their effectiveness.

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Goodell_et_al_October2005.pdf

This policy brief is one in a series based on a study examining the implementation and operational issues of State Pharmacy Assistance Programs (SPAPs). SPAPs exist in 22 states to provide assistance to residents to purchase prescription drugs. Most programs are aimed at the elderly who lack other prescription drug coverage and many are limited to persons with low or moderate income.

Objective: To assess whether Medicaid coverage of smoking cessation services reduces maternal smoking and improves birth outcomes. Methods: Pooled, cross-sectional data for 178,937 women with live births from 1996 to 2008, who were insured by Medicaid in 34 states plus New York City, were used to analyze self-reported smoking before pregnancy (3 months), smoking during the last 3 months of pregnancy, smoking after delivery (3-4 months), infant birth weight, and gestational age at delivery.

Value-based insurance design (VBID) is an approach that attempts to improve the quality of care by selectively encouraging or discouraging the use of specific health care services, based on their potential benefit to patients’ health, relative to their cost. Lowering beneficiary cost sharing or out-of-pocket spending to increase medication adherence is one common element of value-based insurance design. We conducted a systematic review of the peer-reviewed literature to evaluate the evidence of the effects of VBID policies on medication adherence and medical expenditures.

Objective: To examine whether decreases in Medicare outpatient payment rates under the Outpatient Prospective Payment System (OPPS) caused outpatient care to shift toward the inpatient setting. Data Sources/Study Setting: Hospital inpatient and outpatient discharge files from the Florida Agency for Health Care Administration from 1997 through 2008. Study Design: This study focuses on inguinal hernia repair surgery, one of the most commonly performed surgical procedures in the United States.