Suchergebnisse

Estimating the costs attributable to smoking is helpful for evaluating appropriate tax policy, informing both public and private managers of health care, and evaluating alternative smoking cessation programs. While the smoking-attributable costs of chronic conditions have been well studied, these costs are less relevant to health maintenance organizations (HMOs) and employers whose populations are younger and transient. Costs incurred in the short run, such as those related to smoking during pregnancy and environmental tobacco smoke exposure (ETS) of children, are more relevant. In this article, the authors review studies of these sources of smoking-attributable costs as well as studies that focus on smoking-attributable outcomes and costs from the employer or HMO perspective. Subsidies may be necessary to induce employers to recognize the full social benefits of smoking cessation programs.

The changing competitive hospital environment and recent greater availability of patient origin data have stimulated an increased research interest in factors influencing the reason patients are admitted to one hospital over another. Hospital marketers and managed care planners seek information for attracting patients and for negotiating hospital provider networks, respectively. Hospital choice models can help regulators make better informed assessments of the welfare implications of proposed mergers or closures. The literature shows the development of increasingly sophisticated models and techniques for analysis of hospital choice. Recent studies have also related the findings to health policy issues. This review summarizes the historical developments and the cumulative knowledge gained about hospital choice to date, identifies some key issues in need of greater attention, and assesses the potential strengths and limitations of contemporary choice models for making policy impact assessments.

The Affordable Care Act aims to substantially increase public health insurance eligibility among low-income childless adults. The literature suggests that public health insurance may have important implications for labor market participation. With data from the March supplement to the Current Population Survey, difference-in-difference multivariable regression modeling is used to examine the association between state-level public health insurance expansions and the likelihood of full-time employment, part-time employment, and not working among eligible childless adults. Results indicate that public health insurance eligibility is associated with a 2.2 percentage point decrease in full-time employment, a 0.8 percentage point increase in the likelihood of part-time employment, and a 1.4 percentage point increase in the likelihood of not working. These associations were greatest among those with worse health and those aged from 50 to 64 years. This analysis provides important insights into the potential labor market repercussions of health insurance expansions under the Affordable Care Act.

AbstractPrevious studies suggest access to and satisfaction with care may be different for enrollees in S‐CHIP and Medicaid, but it is unclear whether those differences are fully explained by socioeconomic characteristics of the enrollees. We analyze access and satisfaction of three groups of children: Medicaid enrolled, S‐CHIP enrolled, and children who are income eligible for Medicaid but carry a card similar to the state's S‐CHIP children's card. Both enrollees and providers may believe that these children are enrolled in S‐CHIP despite the fact that reimbursement is through the state's Medicaid system. Results indicate that the same network of providers treat, or are perceived by families to treat, the three groups differently. They support the notion that some of the differences in satisfaction between S‐CHIP and Medicaid enrollees are related to unmeasured characteristics (for example, income) of the families in the different programs, but that programmatic identity contributes substantially to differential care experience. © 2007 by the Association for Public Policy Analysis and Management

This study analyzes the 4-year phase-in of Medicaid Primary Care Case Management (PCCM) in Georgia and Alabama. The effect of PCCM implementation on children's primary and preventive care, independent of changes in Medicaid participating providers, was measured by race. Accounting for provider supply, PCCMwas associated with lower use of primary care for all children except white non-Hispanics in urban Georgia. In urban Alabama, PCCM reduced preventive care for white and black non-Hispanic children. This held only for blacks in urban Georgia, while PCCM was associated with increased preventive care among all children in rural Georgia. The negative effect of PCCM was further compounded by negative effects of reduced provider availability. Reductions in office-based Medicaid providers affected Alabama children more often, while reductions in hospital-based physicians had a negative effect for Georgia children. Implementation of PCCM without fee increases may have had unexpected negative effects that differentially affected minority children.

In response to a growing concern that nonprofit hospitals are not providing sufficient benefit to their communities in return for their tax-exempt status, the Internal Revenue Service (IRS) now requires nonprofit hospitals to formally document the extent of their community contributions.

National Institute of Education contract 400-76-0039. ; Distributed to depository libraries in microfiche. ; Series printed on t.p. as Papers in education finance. ; "Presented at the fifty-third Conference of the Western Economic Association, Honolulu and Kona, Hawaii, June 19-26, 1978." ; Bibliography: p. 23. ; Mode of access: Internet.