13 results on '"Fung, Vicki"'
Search Results
2. Care-Seeking Behavior in Response to Emergency Department Copayments
- Author
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Reed, Mary, Fung, Vicki, Brand, Richard, Fireman, Bruce, Newhouse, Joseph P., Selby, Joseph V., and Hsu, John
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- 2005
3. Validation of an Algorithm for Categorizing the Severity of Hospital Emergency Department Visits
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Ballard, Dustin W., Price, Mary, Fung, Vicki, Brand, Richard, Reed, Mary E., Fireman, Bruce, Newhouse, Joseph P., Selby, Joseph V., and Hsu, John
- Published
- 2010
4. Psychiatrist Participation in Private Health Insurance Markets: Paucity in the Land of Plenty.
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Benson, Nicole M., Myong, Catherine, Newhouse, Joseph P., Fung, Vicki, and Hsu, John
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HEALTH insurance ,MENTAL health services ,HEALTH insurance reimbursement ,PSYCHIATRISTS ,INSURANCE claims ,MENTAL health personnel - Abstract
Objective: Access to specialty mental health care may be poor because many psychiatrists do not accept health insurance reimbursement, whereas many patients rely on insurance to help pay for care. The objective of this study was to examine the extent of participation in private insurance by licensed psychiatrists.Methods: Using 2013 Massachusetts licensing data and the All-Payer Claims Database (APCD), the authors performed a cross-sectional analysis of licensed psychiatrists in Massachusetts. The fraction of psychiatrists who filed insurance claims, number of unique patients with insurance claims per psychiatrist, and physician characteristics associated with insurance participation were evaluated.Results: In 2013, Massachusetts had 2,348 licensed psychiatrists. Overall, 79% (N=1,843) had at least one paid claim for an outpatient visit in the APCD, but only 6% (N=151) had claims for at least 300 patients per year (a full caseload). Psychiatrists had a median of 18 patients with claims (mean=73). Compared with psychiatrists 30-39 years since medical school graduation, those within 19 years since graduation were less likely to bill for an outpatient (7-19 years, odds ratio [OR]=0.67, 95% confidence interval [CI]=0.47-0.94) and less likely to have claims for ≥300 patients per year (7-19 years, OR=0.49, 95% CI=0.29-0.83). Participation varied across insurance types (93% for group commercial plans versus 33% for Medicaid managed care plans).Conclusions: Among Massachusetts psychiatrists, participation in the private insurance market appears to be limited. Older psychiatrists are more likely to participate, and patients' access to psychiatrists who accept insurance could worsen as these psychiatrists retire. [ABSTRACT FROM AUTHOR]- Published
- 2020
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5. Adverse Selection into and within the Individual Health Insurance Market in California in 2014.
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Fung, Vicki, Peitzman, Cassandra G. K., Shi, Julie, Liang, Catherine Y., Dow, William H., Zaslavsky, Alan M., Fireman, Bruce H., Derose, Stephen F., Chernew, Michael E., Newhouse, Joseph P., and Hsu, John
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HEALTH insurance , *BODY mass index , *MEDICALLY uninsured persons , *MEDICAL care , *INSURANCE statistics , *HEALTH insurance statistics , *MEDICAL care cost statistics , *COMPARATIVE studies , *DISCRIMINATION in insurance , *RESEARCH methodology , *MEDICAL cooperation , *HEALTH policy , *RESEARCH , *RESEARCH funding , *SOCIOECONOMIC factors , *EVALUATION research , *STATE health plans , *HEALTH insurance exchanges ,PATIENT Protection & Affordable Care Act - Abstract
Objective: The Affordable Care Act (ACA) introduced reforms to mitigate adverse selection into and within the individual insurance market. We examined the traits and predicted medical spending of enrollees in California post-ACA.Data Sources: Survey of 2,103 enrollees in individual market plans, on- and off-exchange, in 2014.Study Design: We compared actual versus potential participants using data from the 2014 California Health Interview Survey on respondents who were individually insured or uninsured. We predicted annual medical spending for each group using age, sex, self-rated health, body mass index, smoking status, and income.Principal Findings: Average predicted spending was similar for actual ($3,377, 95 percent CI [$3,280-$3,474]) and potential participants ($3,257 [$3,060-$3,454]); however, some vulnerable subgroups were underrepresented. On- versus off-exchange enrollees differed in sociodemographic and health traits with modest differences in spending ($3,448 [$3,330-$3,565] vs. $3,175 [$3,012-$3,338]).Conclusions: We did not find evidence of selection into the overall insurance pool in 2014; however, differences by exchange status reflect the importance of including off-exchange enrollees in analyses and the pool for risk adjustment. California's post-ACA individual market has been a relative success, highlighting the importance of state policies and outreach efforts to encourage participation in the market. [ABSTRACT FROM AUTHOR]- Published
- 2018
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6. Impact of Copayment Changes on Children's Albuterol Inhaler Use and Costs after the Clean Air Act Chlorofluorocarbon Ban.
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Galbraith, Alison A., Fung, Vicki, Li, Lingling, Butler, Melissa G., Nordin, James D., Hsu, John, Smith, David, Vollmer, William M., Lieu, Tracy A., Soumerai, Stephen B., and Wu, Ann Chen
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ALBUTEROL , *INHALERS , *CHLOROFLUOROCARBON laws , *PUBLIC health , *MEDICAL care , *DRUG therapy for asthma , *INSURANCE statistics , *HEALTH maintenance organization statistics , *CHLOROFLUOROCARBONS , *COMPARATIVE studies , *HEALTH maintenance organizations , *INSURANCE , *RESEARCH methodology , *MEDICAL cooperation , *RESEARCH , *RESEARCH funding , *RESPIRATORY therapy equipment , *SOILS , *TIME series analysis , *EVALUATION research , *ECONOMICS - Abstract
Objective: To examine changes in children's albuterol use and out-of-pocket (OOP) costs in response to increased copayments after the Food and Drug Administration banned inhalers with chlorofluorocarbon (CFC) propellants.Setting: Four health maintenance organizations (HMOs), two that increased copayments for albuterol inhalers that went from generic CFC-containing to branded CFC-free versions, and two that retained generic copayments for CFC-free inhalers (controls). We included children with asthma aged 4-17 years with commercial coverage from 2007 to 2010.Design: Interrupted time series with comparison series.Data: We obtained enrollee and plan characteristics from enrollment files, and utilization data from pharmacy and medical claims; OOP expenditures were extracted from pharmacy claims for two HMOs with cost data available.Findings: There were no significant differences in albuterol use between the group with increased cost-sharing and controls with respect to changes after the policy change. There was a postpolicy increase of $6.11 OOP per month per child using albuterol among those with increased cost-sharing versus $0.36 in controls; the difference between groups was significant (p < .01).Conclusions: Increased copayments for brand-name CFC-free albuterol after the CFC ban did not lead to a decrease in children's albuterol use, but it led to a modest increase in OOP costs. [ABSTRACT FROM AUTHOR]- Published
- 2018
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7. Expiration of Pandemic-Related Marketplace Insurance Policies: Implications for Affordability and Coverage.
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Hsu, John, Fung, Vicki, and Newhouse, Joseph P.
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HEALTH insurance exchanges , *HEALTH policy , *EPIDEMICS , *COST analysis , *HEALTH insurance , *INSURANCE ,PATIENT Protection & Affordable Care Act - Abstract
This Viewpoint discusses the potential negative effects of not renewing the American Rescue Plan Act, including an increase in out-of-pocket premiums in 2023 and a loss of protections afforded by prior coverage gains. [ABSTRACT FROM AUTHOR]
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- 2022
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8. Nearly One-Third Of Enrollees In California's Individual Market Missed Opportunities To Receive Financial Assistance.
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Fung, Vicki, Liang, Catherine Y., Donelan, Karen, Peitzman, Cassandra G. K., Dow, William H., Zaslavsky, Alan M., Fireman, Bruce, Derose, Stephen F., Chernew, Michael E., Newhouse, Joseph P., and Hsu, John
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HEALTH insurance , *AGE distribution , *CONFIDENCE intervals , *DECISION making , *ENDOWMENTS , *INCOME , *INTERNET , *INTERVIEWING , *RESEARCH methodology , *STATISTICAL sampling , *SEX distribution , *SURVEYS , *TELEPHONES , *MULTIPLE regression analysis , *EDUCATIONAL attainment , *CROSS-sectional method , *DESCRIPTIVE statistics , *ODDS ratio ,HEALTH insurance & economics ,PATIENT Protection & Affordable Care Act - Abstract
The Affordable Care Act includes financial assistance that reduces both premiums and cost-sharing amounts for lower-income Americans, to increase the affordability of health insurance coverage and care. To receive both types of assistance, enrollees must purchase a qualified health plan through a public insurance exchange, and those eligible for the cost-sharing reduction must purchase a silver-tier plan. We estimate that 31 percent of individual-market enrollees in California who were likely eligible for financial assistance purchased plans that were not silver tier or that were not sold on the state's exchange and thus missed opportunities to receive premium or cost-sharing assistance or both. Lower-income enrollees who chose plans not eligible for subsidies had two to three times higher odds of reporting difficulty paying premiums and out-of-pocket expenses during the year, compared to those who chose eligible plans. Regardless of how the structure of the individual market evolves in the coming years, efforts are likely needed to steer lower-income enrollees away from financially suboptimal plan choices. [ABSTRACT FROM AUTHOR]
- Published
- 2017
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9. COBRA ARRA Subsidies: Was the Carrot Enticing Enough?
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Graetz, Ilana, Reed, Mary, Fung, Vicki, Dow, William H., Newhouse, Joseph P., and Hsu, John
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HEALTH insurance subsidies ,HEALTH insurance ,AMERICAN Recovery & Reinvestment Act of 2009 ,UNEMPLOYED people ,TELEPHONE interviewing ,MEDICAL care - Abstract
Objective To help preserve continuity of health insurance coverage during the recent recession, the American Recovery and Reinvestment Act provided a 65 percent Consolidated Omnibus Budget Reconciliation Act ( COBRA) premium subsidy for workers laid off in 2008-2010. We examined COBRA enrollment levels with the subsidy and the health, access, and financial consequences of enrollment decisions. Study Design/Data Collection Telephone interviews linked with health system databases for 561 respondents who were laid off in 2009 and eligible for the COBRA subsidy (80 percent response rate). Principal Findings Overall, 38 percent reported enrolling in COBRA and 54 percent reported having some gaps in insurance coverage since being laid off. After adjustments, we found that those who had higher cost-sharing, who had higher incomes, were older, or were sicker were more likely to enroll in COBRA. COBRA enrollees less frequently reported access problems or that their health suffered because of poor access, but they reported greater financial stress due to health care spending. Conclusion Despite the substantial subsidy, a majority of eligible individuals did not enroll in COBRA, and many reported insurance coverage gaps. Nonenrollees reported more access problems and that their health worsened. Without a mandate, subsidies may need to be widely publicized and larger to encourage health insurance enrollment among individuals who suffer a negative income shock. [ABSTRACT FROM AUTHOR]
- Published
- 2012
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10. High-Deductible Health Insurance Plans: Efforts To Sharpen A Blunt Instrument.
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Reed, Mary, Fung, Vicki, Price, Mary, Brand, Richard, Benedetti, Nancy, Derose, Stephen F., Newhouse, Joseph P., and Hsu, John
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DEDUCTIBLES (Insurance) , *HEALTH insurance , *CONSUMER-driven health insurance , *INTEGRATED health care delivery , *MEDICAL care costs , *INSURANCE premiums , *CONSUMERS , *AWARENESS , *MEDICAL care - Abstract
High deductible—based health insurance plans require consumers to pay for care until reaching the deductible amount. However, information is limited on how well consumers understand their benefits and how they respond to these costs. In telephone interviews, we found that consumers had limited knowledge about their deductibles yet frequently reported changing their care-seeking behavior because of the cost. Poor knowledge limited the effects of the deductible design, with some consumers avoiding care for services that were exempt from the deductible. Consumers need more information and decision support to understand their benefits and to differentiate when care is necessary, discretionary, or unnecessary. [ABSTRACT FROM AUTHOR]
- Published
- 2009
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11. Medicare Beneficiaries' Knowledge of Part D Prescription Drug Program Benefits and Responses to Drug Costs.
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Hsu, John, Fung, Vicki, Price, Mary, Jie Huang, Brand, Richard, Hui, Rita, Fireman, Bruce, and Newhouse, Joseph P.
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MEDICARE , *MEDICAL care for older people , *MEDICARE beneficiaries , *HEALTH insurance , *MEDICAL care costs , *DRUG prices , *BASIC needs , *GOVERNMENT policy - Abstract
The article presents a study to determine Medicare beneficiaries' knowledge of the benefits and cost responses of the Medicare Advantage Prescription Drug plan in the U.S. The study measured awareness of the coverage gap and cost-coping behaviors such as switching medications, non-adherence and the forgoing of basic needs by the elderly in the U.S. The design, setting and participants of the telephone interview study are defined. Research showed a 40% awareness of a coverage gap in the drug plan by those interviewed, while 30% reported engaging in one of the cost-coping behaviors measured.
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- 2008
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12. The impact of generic-only drug benefits on patients' use of inhaled corticosteroids in a Medicare population with asthma.
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Fung, Vicki, Tager, Ira B., Brand, Richard, Newhouse, Joseph P., and Hsu, John
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GENERIC drugs , *CORTICOSTEROIDS , *MEDICARE , *ASTHMA , *HEALTH insurance , *MEDICAL care costs - Abstract
Background: Patients face increasing insurance restrictions on prescription drugs, including generic-only coverage. There are no generic inhaled corticosteroids (ICS), which are a mainstay of asthma therapy, and patients pay the full price for these drugs under generic-only policies. We examined changes in ICS use following the introduction of generic-only coverage in a Medicare Advantage population from 2003-2004. Methods: Subjects were age 65+, with asthma, prior ICS use, and no chronic obstructive pulmonary disorder (n = 1,802). In 2004, 74.0% switched from having a $30 brand-copayment plan to a generic-only coverage plan (restricted coverage); 26% had $15-25 brand copayments in 2003-2004 (unrestricted coverage). Using linear difference-in-difference models, we examined annual changes in ICS use (measured by days-of-supply dispensed). There was a lower-cost ICS available within the study setting and we also examined changes in drug choice (higher- vs. lower-cost ICS). In multivariable models we adjusted for socio-demographic, clinical, and asthma characteristics. Results: In 2003 subjects had an average of 188 days of ICS supply. Restricted compared with unrestricted coverage was associated with reductions in ICS use from 2003-2004 (-15.5 days-of-supply, 95% confidence interval (CI): -25.0 to -6.0). Among patients using higher-cost ICS drugs in 2003 (n = 662), more restricted versus unrestricted coverage subjects switched to the lower-cost ICS in 2004 (39.8% vs. 10.3%). Restricted coverage was not associated with decreased ICS use (2003-2004) among patients who switched to the lower-cost ICS (18.7 days-of-supply, CI: -27.5 to 65.0), but was among patients who did not switch (-38.6 days-of-supply, CI: -57.0 to -20.3). In addition, restricted coverage was associated with decreases in ICS use among patients with both higher- and lower-risk asthma (-15.0 days-of-supply, CI: - 41.4 to 11.44; and -15.6 days-of-supply, CI: -25.8 to -5.3, respectively). Conclusion: In this elderly population, patients reduced their already low ICS use in response to losing drug coverage. Switching to the lower-cost ICS mitigated reductions in use among patients who previously used higher-cost drugs. Additional work is needed to assess barriers to switching ICS drugs and the clinical effects of these drug use changes. [ABSTRACT FROM AUTHOR]
- Published
- 2008
- Full Text
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13. In Consumer-Directed Health Plans, A Majority Of Patients Were Unaware Of Free Or Low-Cost Preventive Care.
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Reed, Mary E., Graetz, Ilana, Fung, Vicki, Newhouse, Joseph P., and Hsu, John
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PREVENTIVE health services , *MANAGED care programs , *SURVEYS , *COGNITION disorders , *CONFIDENCE intervals , *CLINICAL pathology , *EPIDEMIOLOGY , *HEALTH services accessibility , *INSURANCE , *HEALTH insurance , *MEDICAL screening , *MEDICINE information services , *QUESTIONNAIRES , *RESEARCH funding , *STATISTICAL sampling , *CONSUMER information services , *DATA analysis , *MULTIPLE regression analysis , *DESCRIPTIVE statistics , *TREATMENT delay (Medicine) , *ECONOMICS - Abstract
Consumer-directed health plans are plans with high deductibles that typically require patients to bear no out-of-pocket costs for preventive care, such as annual physicals or screening tests, in order to ease financial barriers and encourage patients to seek such care. We surveyed people in California who had a consumer-directed health plan and found that fewer than one in five understood that their plan exempted preventive office visits, medical tests, and screenings from their deductible, meaning that this care was free or had a modest copayment. Roughly one in five said that they had delayed or avoided a preventive office visit, test, or screening because of cost. Those who were confused about the exemption were significantly more likely to report avoiding preventive visits because of cost concerns. Special efforts to educate consumers about preventive care cost-sharing exemptions may be necessary as more health plans, including Medicare, adopt this model. [ABSTRACT FROM AUTHOR]
- Published
- 2012
- Full Text
- View/download PDF
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