Grantee Publication

Effect of an Expenditure Cap on Low- Income Seniors’ Drug Use and Spending in a State Pharmacy Assistance Program

To estimate the impact of a soft cap (a ceiling on utilization beyond which insured enrollees pay a higher copayment) on low-income elders’ use of prescription drugs.

Health Services Research
Vol. 44, No. 3
June 2009
Bishop, C.E., Ryan, A.M., Gilden, D.M., Kubisiak, J., and Thomas, C.P.

Objective.To estimate the impact of a soft cap (a ceiling on utilization beyond which insured enrollees pay a higher copayment) on low-income elders’ use of prescription drugs.

Topic: 
Medicare

Damages Caps in Medical Malpractice Cases

This article reviews the empirical literature on the effects of damages caps and concludes that the better-designed studies show that damages caps reduce liability insurance premiums. The effects of damages caps on defensive medicine, physicians’ location decisions, and the cost of health care to consumers are less clear.

Milbank Quarterly
Vol. 85, No. 2
June 2007
Nelson, L.J., Morrisey, M.A., and Kilgore, M.L.

This article reviews the empirical literature on the effects of damages caps and concludes that the better-designed studies show that damages caps reduce liability insurance premiums. The effects of damages caps on defensive medicine, physicians’ location decisions, and the cost of health care to consumers are less clear. The only study of whether consumers benefit from lower health insurance premiums as a result of damages caps found no impact.

Meeting the Long-Term Care Needs of the Baby Boomers: How Changing Families will Affect Paid Helpers and Institutions

The demand for long-term care services will surge in coming decades when the baby boomers reach their 80s. Declining family sizes, increasing childlessness, and rising divorce rates will limit the number of family caregivers. Rising female employment rates may further reduce the availability of family care, increasing the future need for paid home care. This study projects to 2040 the number of people ages 65 and older with disabilities and their use of long-term care services. The simulations show that even under the most optimistic scenario long-term care burdens on families and institutions will increase substantially.

Urban Institute
May 2007
Johnson, R.W., Toohey, D., and Wiener, J.M.

The demand for long-term care services will surge in coming decades when the baby boomers reach their 80s. Declining family sizes, increasing childlessness, and rising divorce rates will limit the number of family caregivers. Rising female employment rates may further reduce the availability of family care, increasing the future need for paid home care. This study projects to 2040 the number of people ages 65 and older with disabilities and their use of long-term care services.

A Profile of Frail Older Americans and Their Caregivers

Frail older adults are one of the most vulnerable groups in the nation. Disproportionately female, widowed, and in their 80s and 90s, most older people with disabilities living outside of nursing homes have little education and limited financial resources. Given the scarcity of public financing for home-based care, about three-quarters of those receiving assistance rely exclusively on unpaid caregivers. Providing help is often a burden on spouses, children, and friends, leaving some older Americans without the care they need. As the population ages, the demands on government and families will only intensify and put more older people at risk.

Urban Institute
March 2006
Johnson, R.W., and Wiener, J.M.

Frail older adults are one of the most vulnerable groups in the nation. Disproportionately female, widowed, and in their 80s and 90s, most older people with disabilities living outside of nursing homes have little education and limited financial resources. Given the scarcity of public financing for home-based care, about three-quarters of those receiving assistance rely exclusively on unpaid caregivers. Providing help is often a burden on spouses, children, and friends, leaving some older Americans without the care they need.

In-Home Care for Frail Childless Adults Getting By With a Little Help From Their Friends?

Adult children are crucial sources of care for frail older Americans, but childless adults face limited informal care options. This report examines how the absence of children affects the receipt, amount, and source of care.

Urban Institute
April 2006
Johnson, R.W.

Adult children are crucial sources of care for frail older Americans, but childless adults face limited informal care options. This report examines how the absence of children affects the receipt, amount, and source of care. Controlling for health status, financial resources, and demographic characteristics, the analysis indicates that unmarried frail older adults without children are about 31 percent less likely to receive unpaid help from family and friends than those with two or more adult children.

The effect of hospice on Medicare and informal care costs: the U.S. Experience

The effect of hospice on third-party payer costs has long been of great interest in the United States and other nations. The choice of hospice could also influence the costs experienced by patients and family members as compared with when Medicare beneficiaries choose to use normal care. This article considers both types of cost in the context of the United States.

Journal of Pain and Symptom Management
Vol. 38, No. 1
July 2009
Taylor, D.H.

The effect of hospice on third-party payer costs has long been of great interest in the United States and other nations. The choice of hospice could also influence the costs experienced by patients and family members as compared with when Medicare beneficiaries choose to use normal care. This article considers both types of cost in the context of the United States. Hospice provides a rare example of a medical or multiprofessional intervention that improves quality of life for patients while reducing the costs of third-party insurers.

Dynamics In Medicaid And SCHIP Eligibility Among Children In SCHIP’s Early Years: Implications For Reauthorization

Two-thirds of children in the United States were income-eligible for Medicaid or the State Children’s Health Insurance Program (SCHIP) at some point from 1996 to 2000. One in five children were income-eligible for both programs, and 73 percent of children ever eligible for SCHIP were eligible at other times for Medicaid. As SCHIP is reauthorized, Congress will need to give states the tools and financial commitment to assure that uninsured children are enrolled in and retain the coverage for which they are eligible.

Health Affairs
Vol. 26, No. 5
August 2007
Sommers, A.S., Dubay, L., Blumberg, L.J., Blavin, F.E., and Czajka, J.L.

Two-thirds of children in the United States were income-eligible for Medicaid or the State Children’s Health Insurance Program (SCHIP) at some point from 1996 to 2000. One in five children were income-eligible for both programs, and 73 percent of children ever eligible for SCHIP were eligible at other times for Medicaid. As SCHIP is reauthorized, Congress will need to give states the tools and financial commitment to assure that uninsured children are enrolled in and retain the coverage for which they are eligible.

Should Episode-Based Economic Profiles Be Risk Adjusted to Account for Differences in Patients' Health Risks?

To determine whether additional risk adjustment is necessary in economic profiling of physicians when claims data are already grouped into episodes of care, and to measure effects of risk adjustment on cost efficiency rankings of physicians.

Health Services Research
Vol. 41, No. 2
January 2006
Thomas, J.W.

Objective. To determine whether additional risk adjustment is necessary in economic profiling of physicians when claims data are already grouped into episodes of care, and to measure effects of risk adjustment on cost efficiency rankings of physicians.

Data Sources. Four years of inpatient, outpatient, professional, and pharmacy claims data from a mixed model HMO.

Health Plans: Structural Variations and their Effect on Liability

In fashioning legislative and regulatory responses to consumer and plan sponsor concerns about our current health care system, policymakers increasingly find themselves dealing with questions involving the Employee Retirement Income Security Act of 1974 (ERISA) and its relationship to employer-sponsored group health plans.

GW School of Public Health
September 2002
Borzi, P.C.

In fashioning legislative and regulatory responses to consumer and plan sponsor concerns about our current health care system, policymakers increasingly find themselves dealing with questions involving the Employee Retirement Income Security Act of 1974 (ERISA) and its relationship to employer-sponsored group health plans.

Self-Insurance In Times Of Growing And Retreating Managed Care

This paper examines trends in self-insurance and in the content of self-insured plans from 1993 to 2001.

Health Affairs
Vol. 22, No. 2
March 2003
Gabel, J.R., Jensen, G.A., and Hawkins, S.

This paper examines trends in self-insurance and in the content of self-insured plans from 1993 to 2001. The percentage of employees enrolled in self-insured plans fell during these years. Much of the decrease was attributable to the decline of indemnity insurance and the rise of HMO and point-of-service plan enrollment. If the product mix had remained constant throughout these years, self-insured enrollment would have grown between 1993 and 1996 and then declined to its current 50 percent level.

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