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What is known about this topic? We discuss a recently published paper that alleges clinicians are causal agents of non-compliant billing of Medicare. What does this paper add? The paper's arguments are partially supported by unreferenced assertions, potential logical fallacies, inaccurate reporting of referenced material and unsubstantiated rhetoric. What are the implications for practitioners? Due to the lack of substantive evidence, it cannot be concluded that clinicians are the causal agents of non-compliant billing of Medicare. [ABSTRACT FROM AUTHOR]

This paper investigates the effects of health insurance enrollment on health disparities among different racial groups in the United States. Two models were constructed and estimated empirically where a health insurance disparity model was nested in the health disparity model. The Blinder-Oaxaca decomposition method was used to measure potential racial discrimination in health status. The racial gap in health disparities was broken down by endowment and treatment effects. The results show that the health status gap can be explained by potential discrimination in health insurance enrollment between Blacks and Whites. Overall, health insurance enrollment plays a critical role in explaining racial disparities and a racial disparity in the healthcare industry explains a nontrivial portion of the differences in health status. [ABSTRACT FROM AUTHOR]

This paper presents a dynamic general equilibrium model designed to examine the macroeconomic effects and welfare implications of alternative reforms to the US health insurance system. Specifically, it scrutinizes the extent to which health care reform can mitigate inefficiencies stemming from market imperfections in the health insurance industry. The model considers a stochastic overlapping generations framework, incorporating heterogeneous agents who are subject to uncertain health shocks. These individuals make optimal decisions regarding labor supply, health insurance, and medical services. Given that the optimal levels of medical consumption and hours worked are endogenous, this setting encapsulates general equilibrium effects. The model is calibrated to US data, and numerical simulations suggest that suitable adjustments to the present health insurance system can broaden coverage and enhance welfare. This improvement is achieved by reducing adverse selection, improving overall health status, and lessening tax distortions on labor supply. [ABSTRACT FROM AUTHOR]

Aims: To identify the barriers and facilitators to healthcare for people without documentation status. Design: We conducted a systematic integrative literature review following the Whittemore and Knafl methodology. Methods: Literature search was conducted to identify studies addressing barriers or facilitators to healthcare for people without documentation status in the United States between 2012 and 2022. Studies were critiqued for quality, with results analysed thematically using the social‐ecological model. Data Sources: Searches were conducted in PubMed, PAIS, Web of Science, CINAHL and Psych Info in October 2022. Results: The review incorporated 30 studies (19 qualitative and 11 quantitative). People without documentation status encountered numerous healthcare barriers such as intrapersonal (lack of financial resources and health insurance, fear), interpersonal (language and cultural discrepancies, discrimination), community (bureaucratic requirements, anti‐immigrant rhetoric) and policy‐related barriers. Conversely, linguistically and culturally competent care, empathetic and representative staff, health navigators, safety‐net clinics and supportive federal policies emerged as key facilitators. Conclusion: These findings illuminate the complex healthcare disparities experienced by people without documentation status and underscore facilitators enhancing care accessibility. Future research is needed to explore interventions to increase access to care for this population. Impact: This paper provides a comprehensive examination of the complex barriers and facilitators to healthcare for people without documentation status in the United States. The findings support the value of universal healthcare access, a priority of the World Health Organization, and can inform healthcare policies and practices worldwide. Reporting Method: The review was reported following the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses framework. Patient or Public Contribution: No patient or public contribution was needed. Trial and Protocol Registration: The study protocol was registered with the PROSPERO database (registration number: CRD42022366289). [ABSTRACT FROM AUTHOR]

Applying the behavioral model of health services utilization to data from the United States, this study examined immigrant children's use of physician and dentist visits, hospital care, and prescribed medication. We employed data describing 9759 immigrant parents and children who participated in 2021's National Survey of Children's Health. Logistic regression results negatively linked physician visits to child health, child age, Asian children, fathers, lower parent education, lower family income, uninsured children, and parent's U.S. residence under 5 years. Dentist visits were positively associated with child age, girls, Hispanic children, parent education, family income, public/private health insurance coverage, and U.S.-born children, but such use was associated negatively with Asian children. Hospital use was positively associated with poor child health, Black children, children of "other" race/ethnicity, younger parent age, enrolled in health insurance, and parent's U.S. residence under 5 years. The use of prescribed medication was negatively associated with Asian children, younger child age, lower parent education, uninsured child, and lack of English proficiency. The paper's conclusion suggests policymakers expand Medicaid and CHIP eligibility among immigrant children and suggests community education to foster awareness of children's physical and oral health needs and of Medicaid, CHIP, and prescription assistance programs. The conclusion calls for healthcare providers and social workers to accommodate and respect immigrants' traditional health-related beliefs, showing cultural competence. [ABSTRACT FROM AUTHOR]

There are at least two sources of health insurance coverage estimates in the United States: the Behavioral Risk Factor Surveillance System (BRFSS) and the Small Area Health Insurance Estimates (SAHIE) program. This paper addresses the integration of BRFSS and SAHIE data using multilevel models that account for the different levels of aggregation at which data are available and for the different errors to which data are subject to. The uncertainty in the initial state-level estimates available from BRFSS and SAHIE is improved by borrowing information from both sources and across geographies. County-level model estimates are produced on both BRFSS and SAHIE scales, improving the usability of the BRFSS public-use data and inspiring possible extensions to estimation of BRFSS quantities other than health insurance coverage. The application uses 2018 public-use data. Parallels to small area estimation models and measurement error models are briefly discussed. [ABSTRACT FROM AUTHOR]

Abstract Public pay-for-performance (P4P) programs tie hospital payments to predetermined sets of quality measures and are intended to encourage or discourage certain outcomes. To the extent that financial penalties from these programs induce some response by hospitals, such penalties may translate into higher negotiated payments from commercial insurance payers. In this paper, we employ data on commercial insurance payments from a large, multi-payer database to study the extent to which penalties levied under the Hospital Readmission Reduction Program (HRRP) and the Hospital Value-Based Purchasing (HVBP) program, two major P4P components of the Affordable Care Act, caused changes in private hospital payments. We find that the bulk of any penalties resulting from HRRP and HVBP are borne by private insurance patients in the form of higher private insurance payments. Specifically, we show that HRRP and HVBP financial penalties led to increases in private payments of 1.9 percent, with effects concentrated among circulatory system procedures. These penalties were also associated with a 3.1 percent reduction in Medicare discharges. Our estimates are larger for hospitals with higher shares of privately insured patients, which suggests the importance of hospital bargaining power in facilitating higher commercial insurance payments. [ABSTRACT FROM AUTHOR]

The article offers the author's comment on the article "The Early Impact of the Affordable Care Act, State by State" by Amanda E. Kowalski. The author says that the paper provides an important preview about the impact of the U.S. Affordable Care Act (ACA) on insurance coverage in the individual market. An overview of the paper, which is based on data from the National Association of Insurance Commissioners (NAIC), is also provided.

Scientists, public servants, and patient advocates alike increasingly question the validity of published scientific results, endangering the public’s acceptance of science. Here, I argue that emerging flaws in the integrity of the peer review system are largely responsible. Distortions in peer review are driven by economic forces and enabled by a lack of accountability of journals, editors, and authors. One approach to restoring trust in the validity of published results may be to establish basic rules that render peer review more transparent, such as publishing the reviews (a practice already embraced by some journals) and monitoring not only the track records of authors but also of editors and journals. [ABSTRACT FROM AUTHOR]

In this paper, we develop a life cycle model that features pecuniary and non-pecuniary investments in health in order to rationalize the socioeconomic gradients in health and life expectancy in the United States. Agents accumulate health capital, which affects labor productivity, utility, the distribution of medical spending shocks, and life expectancy. We find that unequal health insurance coverage plays a negligible role in generating the observed gaps in health and longevity. Universal health insurance increases preventive medical spending but not time spent in health promoting activities, as individuals are no longer worried about avoiding high curative medical expenditure shocks due to increased health insurance coverage. Our findings suggest that differences in lifetime income, preferences, and health shocks are the main determinants of inequality in life expectancy. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to provide a systematic review of empirical evidence on the labour market effects of health insurance from the supply side. Design/methodology/approach: The study covers the largest peer-reviewed and working paper databases for labour economics and health studies. These include Web of Science, Google Scholar, Pubmed and the most popular economics working paper sources such as NBER, ECONSTOR, IDEAS, IZA, SSRN, World Bank Working Paper Series. The authors follow the PRISMA 2009 protocol for systematic reviews. Findings: The collection includes 63 studies. The outcomes of interest are the number of hours worked, the probability of employment, self-employment and the level of economic formalisation. The authors find that the current literature is vastly concentrated on the USA. Spousal coverage in the USA is associated with reduced labour supply of secondary earners. The effect of Medicaid in the USA on the labour supply of its recipients is ambiguous. The employment-coverage link is an important determinant of the labour supply of people with health problems and self-employment decisions. Universal coverage may create either an incentive or a disincentive to work depending on the design of the system. Finally, evidence on the relationship between health insurance and the level of economic formalisation in developing countries is fragmented and limited. Practical implications: This study reviews the existing literature on the labour market effects of health insurance from the supply side. The authors find a large knowledge gap in emerging economies where health coverage is expanding. The authors also highlight important literature gaps that need to be filled in different themes of the topic. Originality/value: This is the first systematic review on the topic which is becoming increasingly relevant for policy makers in developing countries where health coverage is expanding. [ABSTRACT FROM AUTHOR]

This paper identifies the effect of the Affordable Care Act's dependent coverage mandate on health insurance coverage and labor market outcomes among young adults by exploiting the discrete change in health insurance coverage at age 26. Using a regression discontinuity design, we find that aging out from the ACA's dependent coverage mandate is associated with up to a 4.2-percentage-point decrease in private insurance coverage at age 26. We also find that aging out from the mandate is significantly associated with an increase in the probability of being employed. However, we do not find any significant changes in hourly wage, weekly working hours or job mobility at age 26. [ABSTRACT FROM AUTHOR]

As a country, the United States spends significantly more on healthcare than other advanced industrialized countries, and Americans have comparably worse health outcomes. Both are developments of the last four decades. In this paper, we look at how change in antitrust and patent law and thus change in market power in the largest four subsectors of healthcare, hospitals, physician groups, prescription drugs, and net medical insurance, have contributed to the increasing cost of medical care in the United States. We show that the annual rent – the degree to which health care is overpriced as a result of market power – was between 2.47 and 4.30 percent of GDP in 2016 – truly a big cost for big medicine. [ABSTRACT FROM AUTHOR]

Objective: Immigrant health discussions often focus on acculturation and omit discussions on historical events that may underlie health differences among immigrant older adults. This paper provides a historical overview of immigration policy and flows to the U.S. and examines insurance access and health difficulties by sending country. Methods: We analyzed the "Immigrants Admitted to the United States, Fiscal Years 1972–2000" and 2015–2019 American Community Survey datasets to examine the number of admitted immigrants, sociodemographic profiles for current immigrant older adults, and the predicted probabilities of health insurance access and health difficulties. Results: Our results highlight alignment of immigration flows with immigration legislation and vast heterogeneity in migration, health, and healthcare access of immigrants by sending country. Discussion/Implications: Public health practitioners must consider how historical events and social factors contribute to the healthcare access and health of immigrant populations, as demographic shifts will require interventions that promote equitable healthy aging. [ABSTRACT FROM AUTHOR]

Purpose - New hepatitis C medicines such as sofosbuvir underline the need to balance considerations of innovation, clinical evidence, budget impact and equity in health priority-setting. The purpose of this paper is to examine the role of public participation in addressing these considerations. Design/methodology/approach - The paper employs a comparative case study approach. It explores the experience of four countries - Brazil, England, South Korea and the USA - in making coverage decisions about the antiviral sofosbuvir and involving the public and patients in these decision-making processes. Findings - Issues emerging from public participation ac tivities include the role of the universal right to health in Brazil, the balance between innovation and budget impact in England, the effect of unethical medical practices on public perception in South Korea and the legitimacy of priority-setting processes in the USA. Providing policymakers are receptive to these issues, public participation activities may be re-conceptualized as processes that illuminate policy problems relevant to a particular context, thereby promoting an agenda-setting role for the public. Originality/value - The paper offers an empirical analysis of public involvement in the case of sofosbuvir, where the relevant considerations that bear on priority-setting decisions have been particularly stark. The perspectives that emerge suggest that public participation contributes to raising attention to issues that need to be addressed by policymakers. Public participation activities can thus contribute to setting policy agendas, even if that is not their explicit purpose. However, the actualization of this contribution is contingent on the receptiveness of policymakers. [ABSTRACT FROM AUTHOR]

The dependent coverage expansion (DCE), a component of the Affordable Care Act, required private health insurance policies that cover dependents to offer coverage for policyholders' children through age 25. This review summarizes peer-reviewed research on the impact of the DCE on the chain of consequences through which it could affect public health. Specifically, we examine the impact of the DCE on insurance coverage, access to care, utilization of care, and health status. All studies find that the DCE increased insurance coverage, but evidence regarding downstream impacts is inconsistent. There is evidence that the DCE reduced high out-of-pocket expenditures and frequent emergency room visits and increased behavioral health treatment. Evidence regarding the impact of the DCE on health is sparse but suggestive of positive impacts on self-rated health and health behavior. Inferences regarding the public health impact of the DCE await studies with greater methodological diversity and longer follow-up periods. [ABSTRACT FROM AUTHOR]

The decoupling of child Medicaid from the cash welfare system greatly increased access to public health insurance for low‐income children in the United States. In this paper, I show that the federally mandated public health insurance expansions of the late‐1980s and early‐1990s significantly increased the number of public high school completers in the 2000s. Using the legislated generosity of a state's child Medicaid program as a time‐varying, exogenous source of variation in a quasi‐experimental design, I find substantively large declines in the dropout rate and, importantly, large increases in traditional 4‐year graduation rates. Results for both measures are driven by Hispanic and White students, the two groups experiencing the greatest within‐group increases in eligibility due to the decoupling of child Medicaid from the Aid to Families with Dependent Children program. In addition, I find evidence that increases in the length of childhood years covered (e.g., through age 5 vs. through age 17) leads to greater gains in completion rates. This suggests that public health insurance coverage throughout childhood produces the largest effect. [ABSTRACT FROM AUTHOR]

Importance: Recent discussion has focused on questions related to the repeal and replacement of portions of the Affordable Care Act (ACA). However, issues central to the future of health and health care in the United States transcend the ACA provisions receiving the greatest attention. Initiatives directed to certain strategic and infrastructure priorities are vital to achieve better health at lower cost.Objectives: To review the most salient health challenges and opportunities facing the United States, to identify practical and achievable priorities essential to health progress, and to present policy initiatives critical to the nation's health and fiscal integrity.Evidence Review: Qualitative synthesis of 19 National Academy of Medicine-commissioned white papers, with supplemental review and analysis of publicly available data and published research findings.Findings: The US health system faces major challenges. Health care costs remain high at $3.2 trillion spent annually, of which an estimated 30% is related to waste, inefficiencies, and excessive prices; health disparities are persistent and worsening; and the health and financial burdens of chronic illness and disability are straining families and communities. Concurrently, promising opportunities and knowledge to achieve change exist. Across the 19 discussion papers examined, 8 crosscutting policy directions were identified as vital to the nation's health and fiscal future, including 4 action priorities and 4 essential infrastructure needs. The action priorities-pay for value, empower people, activate communities, and connect care-recurred across the articles as direct and strategic opportunities to advance a more efficient, equitable, and patient- and community-focused health system. The essential infrastructure needs-measure what matters most, modernize skills, accelerate real-world evidence, and advance science-were the most commonly cited foundational elements to ensure progress.Conclusions and Relevance: The action priorities and essential infrastructure needs represent major opportunities to improve health outcomes and increase efficiency and value in the health system. As the new US administration and Congress chart the future of health and health care for the United States, and as health leaders across the country contemplate future directions for their programs and initiatives, their leadership and strategic investment in these priorities will be essential for achieving significant progress. [ABSTRACT FROM AUTHOR]

This paper investigates the effect of the Affordable Care Act's Medicaid expansion on the retirement decision of low-educated adults aged 55-64. I employ a difference-in-differences strategy that exploits the timing and expansion decisions of states for adults without dependent children. I find that the expansions increase Medicaid enrollment for both men and women. The estimates also suggest that the expansions result in women retiring early, whereas there is no significant change in the retirement behavior of men. These findings imply that the effect of health insurance on women's retirement decisions may depend on men's labor market responses to health insurance. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to answer the following research question: at the time of founding of a startup, what entrepreneurial conditions would influence the long-term offerings of HR benefits? To answer this question, our study examines the effects of four founding conditions of startups – total assets, founder's education, industry experience and startup experience – on the basis of the resource-based view of firms.Design/methodology/approach Using data from the Kauffman Firm Survey (KFS) conducted in the period 2005–2010, this paper analyzed the relationships between the founding conditions and the offering of HR benefits by 4,148 new ventures during the first five years after founding. In addition, this paper examined the relationships of the same founding conditions to the offering of each of seven specific benefits: alternative work schedule, bonus plan, health insurance, paid time off, retirement plan, tuition reimbursement and stock options.Findings Three conditions at founding – total assets, founders' education level, industry experience – have a positive and enduring influence on the offering of HR benefits to the employees. Startup experience has a significant effect on benefit offerings during the first year after founding but no significant effect on benefit offerings in subsequent years. All founding conditions have significant and long-lasting positive effects on each benefit, except for startup experience, which has a negative effect on some benefits.Originality/value The HRM literature indicates that there has been a surprising gap between practical interest and academic research with regard to benefits. In addition, there is a dearth of research on how entrepreneurs make strategic decisions such as offering benefits to their employees. The study represents an attempt to fill in this gap. [ABSTRACT FROM AUTHOR]

Background. Foreign-born people encounter disproportionate health care access barriers compared with U.S.-born adults. Few studies in the past decade have examined how characteristics of foreign-born people influence access to health care. Methods. An integrative review regarding health care access for foreign-born people was conducted using Whittemore and Knafl's framework. Andersen's behavioral model of health care utilization was used to explain the findings. We searched electronic databases and identified 33 peerreviewed papers for inclusion. Results. The reviewed articles represented a broad spectrum of research evaluating health care access. Barriers to health care access for foreign-born people are multifactorial and driven by insurance status, citizenship, immigration status, and English language proficiency. Conclusion. Future research must comprehensively examine the unmet health needs and predictors of access among foreign-born people. [ABSTRACT FROM AUTHOR]

A majority of married couples in the USA take advantage of the fact that employers often provide health insurance coverage to spouses. When older spouses become eligible for Medicare, however, many of them can no longer provide their younger spouses with coverage. In this paper, we study how spousal eligibility for Medicare affects the health insurance and health care access of younger spouses. We find that spousal eligibility for Medicare results in younger spouses no longer having employers pay for their insurance and being less likely to have employer-sponsored coverage. Instead, younger spouses switch to privately purchased coverage, which tends to be worse than what they had before their spouses became eligible for Medicare. We also find suggestive evidence that younger spouses are less likely to use health care services after their older spouses become eligible for Medicare. [ABSTRACT FROM AUTHOR]

This paper considers the availability of data for addressing questions related to health insurance and health care and the potential contribution of a new household panel study. The paper begins by outlining some of the major questions related to policy and concludes that survey data on health insurance, access to care, health spending, and overall economic well-being will likely be needed to answer them. The paper considers the strengths and weaknesses of existing sources of survey data for answering these questions. The paper concludes that either a new national panel study, an expansion in the age range of subjects in existing panel studies, or a set of smaller changes to existing panel and cross-sectional surveys, would significantly enhance our understanding of the dynamics of health insurance, access to health care, and economic well-being. [ABSTRACT FROM AUTHOR]

Political repression played a central role in shaping the political complexion of the American medical profession, the policies it advocated, and those allowed to function comfortably in it. Previous work on the impact of McCarthyism and medicine focuses heavily on the mid-century failure of national health insurance (NHI) and medical reform organizations that suffered from McCarthyist attacks. The focus is national and birds-eye but says less about the impact on the day-to-day life of physicians caught in a McCarthyist web; and how exactly the machinery of political repression within the medical profession worked on the ground. This study shifts orientation by using the abrupt dismissal of three Los Angeles physicians from their jobs as a starting point for exploring these dynamics. I argue that the rise of the medical profession and the repressive state at mid-century, frequently studied apart, worked hand-in-hand, with institutions from each playing symbiotic and mutually reinforcing roles. I also explore tactics of resistance -- rhetorical and organizational -- to medical repression by physicians who came under attack. [ABSTRACT FROM AUTHOR]

This paper studies the impact of advertising as a channel for risk selection in Medicare Advantage. We provide evidence that insurer advertising is responsive to the gains from risk selection. Then we develop and estimate an equilibrium model of Medicare Advantage with advertising, allowing rich individual heterogeneity. Our estimates show that advertising is effective in attracting healthy individuals who are newly eligible for Medicare, contributing to advantageous selection into Medicare Advantage. Moreover, risk selection through advertising substantially lowers premiums by improving insurers' risk pools. The distributional implication is that unhealthy consumers may be better off through cross-subsidization from healthy individuals. (JEL D81, G22, I13, I18, M37) [ABSTRACT FROM AUTHOR]

This paper provides new evidence that Medicaid’s introduction reduced infant and child mortality in the 1960s and 1970s. Mandated coverage of all cash welfare recipients induced substantial cross-state variation in the share of children immediately eligible for the program. Before Medicaid, higher- and lower-eligibility states had similar infant and child mortality trends. After Medicaid, public insurance utilization increased and mortality fell more rapidly among children and infants in high-Medicaid-eligibility states. Mortality among nonwhite children on Medicaid fell by 20 percent, leading to a reduction in aggregate nonwhite child mortality rates of 11 percent. [ABSTRACT FROM AUTHOR]

Applying Andersen's health care utilization model, this paper shows the prevalence of immigrants' medical and dental tourism and associated factors. An analysis of the 2003 New Immigrant Survey data shows that about 17% of immigrants received medical care in a foreign country, whereas about one-third obtained dental care outside the United States. Latino immigrants have a higher prevalence of both types of tourism than their Asian counterparts. Race, level of education, and health insured status are commonly associated with medical and dental tourism. The findings contribute to the scarce literature on immigrants' health care utilization and medical and dental tourism. [ABSTRACT FROM AUTHOR]

This article discusses individual and systemic barriers to accessing behavioral healthcare, tailoring the examination to the specific needs of Asian Americans (AAs). Some barriers include language barriers, lack of access to behavioral health care, and providers that may not be culturally sensitive to patients' needs. These barriers lead to the underuse of health services and worse mental health outcomes. AAs are said to be the "model minority," a term most often to describe Chinese Americans, East Asians or South-eastern Asians. This is a myth; AAs with behavioral health needs encounter numerous barriers. Among the barriers are health insurance coverage, especially Medicaid expansion, which is not available in every state. Also, healthcare workers and providers are not always prepared to treat behavioral health needs in their primary care practice. This paper highlights the need to further investigate these topics in order to help eliminate the disparities that still exist in our growing populations of racial and ethnic minorities from the standpoint of healthcare practitioners in their practices. Asian Americans now comprise the largest growing minority group in the United States (US). Asian Americans include all those that may be born in any Asian countries, or born in the US to parents who are not native English speakers. However, there remains insufficient comprehensive discussion and action to reduce the barriers to behavioral healthcare they face. It is important to tailor an all-inclusive agenda with the purpose of eliminating racial and ethnic disparities in behavioral healthcare for AAs in the US. [ABSTRACT FROM AUTHOR]

A 2010 national policy change due to the Affordable Care Act allowed dependent children to remain on parental health insurance policies until age 26. Evidence shows the mandate increased insurance coverage among affected young adults and also increased premiums for family health insurance policies. In this paper, we investigate the use of dependent tax exemptions as a mechanism families could use to pay for increased costs associated with expanded coverage. Using data on households from the Medical Expenditure Panel Survey, we use a difference-in-difference methodology comparing changes in the likelihood of being claimed as a dependent on a tax return for the 19-25 year olds affected by the coverage mandate compared to 16-18 year olds that were unaffected. We find a significant increase in dependent tax exemptions among 19-25 year olds following implementation of the dependent coverage mandate. Family income gains from switching an exemption from a young adult child to the parent would shift a substantial portion of young adult insurance coverage costs (ultimately medical costs) to other taxpayers. Though we point to family health insurance cost as a likely driver of the increased dependent tax exemptions, we cannot rule out a role for other outcomes also affected by the mandate, including labor market changes among 19-25 year olds. We further compare the overall social costs and benefits of the mandate and show that absent significant health improvement to date, welfare gains likely depend on the positive contribution of young adults to insurance pools in terms of lower average costs. [ABSTRACT FROM AUTHOR]

Over the past few decades, healthcare expenditures in the United States have increased due to a variety of different factors. Depending on their insurance plans, Americans have varying levels of health insurance coverage and may need to make co-payments or pay fully for specific health services. According to multiple studies, health insurance does appear to increase the utilization of healthcare services, except emergency services. Demographic factors such as age, citizenship, and race/ethnicity, as well as the type of health service demanded, all appear to influence the consumption of healthcare in the United States. However, many existing studies conducted in this area are not experimental or randomized, which may result in a lack of validity of the estimated relationship between insurance and healthcare utilization due to confounding variables. A new experimental study, similar to the RAND HIE study, is needed to provide insight into the current relationships between insurance and healthcare utilization, taking into consideration changes in legislation. [ABSTRACT FROM AUTHOR]

The Affordable Care Act (ACA) not only changed the landscape of health insurance coverage in the United States but also affected the relationship between working decisions and health insurance. In this paper, we estimate the impact of the ACA on the near elderly (ages 60–64) in the 5 years after the implementation of its key provisions in early 2014. We exploit variation across geographic areas in the preexisting level of uninsurance and use 65–69-year-olds, whose insurance coverage was unaffected by the ACA, as a within-region control group. Our findings indicate that the ACA increased health insurance coverage among the near elderly by 4.5 percentage points and reduced their labor force participation rate by 0.6 percentage points. [ABSTRACT FROM AUTHOR]

Eighty-nine percent of U.S. health expenditures are paid by third-parties. Yet in Singapore with universal healthcare and higher per capita GDP, third-parties pay only 42 percent because households use Health Savings Accounts to pay providers directly, promoting efficiency and competition and medical prices 70 percent lower than U.S. prices. This paper offers a policy proposal that achieves Singapore levels of direct pay, overcoming high U.S. medical prices, unfavorable income distribution and other constraints, by utilizing flexible deductibles based on HSA balances, subsidies, and lines of credit. Non-elderly households receiving third-party payments are reduced from 83 to 10 percent and non-elderly third-party expenditures to 40 percent. [ABSTRACT FROM AUTHOR]

Despite the growth in health insurance products that differentially cover preventive care and nonpreventive care, little is known about how preventive care utilization responds to targeted changes in coverage. Using administrative data from a large company, this paper examines the implementation of an insurance benefit design which differentially increased the price of nonpreventive care while decreasing the price of prevention. Leveraging a difference-in-differences research strategy, we find that preventive care utilization did not increase and even declined due to the differential price change. This evidence indicates a meaningful negative cross-price effect, suggesting that nonpreventive care and preventive care are complements. ( JEL I13, I11) [ABSTRACT FROM AUTHOR]

Purpose As of 2011, the average US state had 37 health insurance benefit mandates, laws requiring health insurance plans to cover a specific treatment, condition, provider, or person. This number is a massive increase from less than one mandate per state in 1965, and the topic takes on a new significance now, when the federal government is considering many new mandates as part of the “essential health benefits” required by the Affordable Care Act. The paper aims to discuss these issues.Design/methodology/approach The authors use fixed effects estimation on 1996-2010 data to determine why some states pass more mandates than others.Findings The authors find that the political strength of health care providers is the strongest determinant of mandates.Originality/value A large body of literature has attempted to evaluate the effect of mandates on health, health insurance, and the labor market. However, previous papers did not consider the political processes behind the passage of mandates. In fact, when they estimate the laws’ effect, almost all papers on the subject assume that mandates are passed at random. The paper opens the way to estimating the causal effect of mandates on health insurance and the labor market using an instrumental variables strategy that incorporates political information about why mandates get passed. [ABSTRACT FROM AUTHOR]

While basic access to clean water is critical, another important issue is the affordability of water access for people around the globe. Prior international work has highlighted that a large proportion of consumers could not afford water if priced at full cost recovery levels. Given growing concern about affordability issues due to rising water rates, and a comparative lack of work on affordability in the developed world, as compared to the developing world, more work is needed in developed countries to understand the extent of this issue in terms of the number of households and persons impacted. To address this need, this paper assesses potential affordability issues for households in the United States using the U.S. EPA’s 4.5% affordability criteria for combined water and wastewater services. Analytical results from this paper highlight high-risk and at-risk households for water poverty or unaffordable water services. Many of these households are clustered in pockets of water poverty within counties, which is a concern for individual utility providers servicing a large proportion of customers with a financial inability to pay for water services. Results also highlight that while water rates remain comparatively affordable for many U.S. households, this trend will not continue in the future. If water rates rise at projected amounts over the next five years, conservative projections estimate that the percentage of U.S. households who will find water bills unaffordable could triple from 11.9% to 35.6%. This is a concern due to the cascading economic impacts associated with widespread affordability issues; these issues mean that utility providers could have fewer customers over which to spread the large fixed costs of water service. Unaffordable water bills also impact customers for whom water services are affordable via higher water rates to recover the costs of services that go unpaid by lower income households. [ABSTRACT FROM AUTHOR]

With the implementation of the Affordable Care Act (ACA), many homeless persons who previously lacked health insurance gained medical coverage. This paper describes the experiences of homeless persons in accessing and using primary care services, post-implementation of the ACA. Twenty-six semi-structured interviews were completed with homeless persons and primary care providers/staff. Via thematic analysis, themes were identified, categorized by: factors which influence primary care access and use patterns, and strategies to promote consistent primary care use. Maintaining insurance and leveraging systems-based strategies to support primary care access and use may address health disparities and promote health equity. [ABSTRACT FROM AUTHOR]

This paper describes sociodemographic, sexual risk behavior, and clinical care factors associated with sustained viral suppression (SVS) among heterosexual Black men with diagnosed HIV in the US. Sample was 968 men, 2015–2017 cycles of Medical Monitoring Project. We used prevalence ratios and a multivariable logistic regression model to identify independent predictors of SVS. About 9% of sexually active men had sex that carries a risk of HIV transmission. Nearly 2/3 lived at or below the poverty level, 13% were under or uninsured, 1/4 experienced food insecurity and 15% reported recent homelessness. About 26% were not engaged in HIV care, 8% not currently taking antiretroviral therapy (ART) and 59% had SVS. Among men taking ART, care engagement and adherence were the only significant independent predictors of SVS. Efforts to increase VS should focus on increasing ART use, care engagement, and ART adherence, and include strategies that address the social and structural factors that influence them. [ABSTRACT FROM AUTHOR]

While the unemployment insurance (UI) program is one of the largest safety net programs in the United States, research on its benefits is limited. This paper exploits plausibly exogenous changes in state UI laws to empirically estimate whether UI generosity mitigates any of the previously documented negative health effects of job loss. The results show that higher UI generosity increases health insurance coverage and utilization, with stronger effects during periods of high unemployment rates. During such periods, higher UI generosity also leads to improved self-reported health. Finally, I find no effects on risky behaviors or health conditions. [ABSTRACT FROM AUTHOR]

The boundaries of what constitutes "sufficient" health have always been open and, as such, health care has proven to be an opportune area for profit growth. In the United States, the allure of health as a market commodity has proven very strong, but even here it cannot be a mere spontaneous product of the market. It requires government to foster and develop public policy that effectively promotes and maintains health care delivery across the population. Historically, U.S. public policy has veered away from anything akin to universal care, and it has typically been understood as an outlier among advanced industrial states. But, simultaneously, it is also the largest health care market in the world, soon to engulf a full fifth of its GDP. In this paper, I argue that the complicated dynamic between a growing market in health delivery and a patchwork of political reforms has encouraged "adaptive accumulation," a process whereby capital secures optimized accumulation outcomes from enhanced government intervention, deriving extra-market benefits along the way. To make this argument, I explore critical components of the health system, including Medicare Advantage, Medicare Part D, as well as the Affordable Care Act and its aftermath. [ABSTRACT FROM AUTHOR]

This paper investigates the influence of goal awareness and IT self-efficacy on job satisfaction based on the motivation sequence model, goal-setting theory, and social cognitive theory. Using a large-scale field survey of healthcare enterprise resource planning (ERP) system users (n = 352), this study investigates these relationships and provides important insight to healthcare ERP system researchers and managers. Both goal awareness and IT self-efficacy influence positive job satisfaction of healthcare ERP system users, as expected. Furthermore, the influence of goal awareness is stronger when the role of ERP systems is highly perceived for decision-making of the job. There was no interaction effect between goal awareness and IT self-efficacy in thepost hocanalysis. The model is significantly supported by the empirical test with the large number of field data from healthcare ERP system users in the healthcare company. Practical and academic implications are discussed in the paper. [ABSTRACT FROM AUTHOR]

This paper compares the discursive frames utilised by several national American Muslim organisations to craft an "Islamic" argument for healthcare reform via an expansion of health insurance coverage in the United States with Islamic ethico-legal opinions (fatwas) of U.S.-based jurists regarding the permissibility of purchasing health insurance. I analyse the differing ways in which these producers of "Islamic bioethics" material ground their arguments and draw on vocabulary from other discourses. The paper closes by reflecting upon the socio-political undercurrents that may contribute to the differences and disconnections between the ways in which these bioethics stakeholders produce their outputs and by arguing that further developing the field of Islamic bioethics will require concerted multidisciplinary engagements that clarify the distinctive nature of Islamic norms. [ABSTRACT FROM AUTHOR]

This paper presents an empirical study of endogenous treatment effects in the presence of heterogeneous responses. We estimate the incentive and selection effects of having prescription drug coverage on total drug expenditures using a sample from the Medicare Current Beneficiary Survey (MCBS). A Dirichlet process mixture (DPM) model is used to model the heterogeneity in treatment effects. Rather than estimating a finite mixture model with a fixed number of components, we specify a DP prior on the parameters, thus allowing the data and prior knowledge to determine the number of components. Endogeneity is modeled by the covariance of the error terms of the selection and the outcome equations in a two-equation selection model. We find that there are strong incentive and advantageous selection effects, with the average treatment effect and the average treatment effect for the treated estimated at $1132 and $858, respectively. Substantial heterogeneity is found to exist in the selection effects, particularly for those having lower drug expenditures. [ABSTRACT FROM AUTHOR]

The increased funding provided for Community Health Worker (CHW) hiring and training as part of the COVID‐19 pandemic response was to increase their impact in alleviating the effects of negative social determinants of health in the lives of the most vulnerable individuals and communities. This enhanced use of CHW in vulnerable populations can also be used to improve access to such populations for applied research to study ways to improve health outcomes for low‐income minority populations. We carried out a feasibility study using the State CHW association as partners to reach CHWs working with low‐income minority population. Three hundred and three (303) clients of CHWs were interviewed on various demographic, health access, and employment information and both univariate and multivariate analyses was used to determine factors associated with being unvaccinated against COVID‐19 and chi‐squared used to determine if employment was associated with having health insurance. About half of the clients self‐identified as Black/African American and half as Hispanic. Two‐thirds were women and 52.1% were unemployed and 55.1% had no health insurance. There was no association between employment status and having health insurance. Majority (71.6%) had received one dose of a type of COVID‐19 vaccine and being younger and being African American were associated with not getting a dose of COVID‐19 vaccine, as well as being unemployed and not having health insurance. Most of the clients came to see the CHW about a Health/Healthcare issue of the five social determinants of health (SDOH). There were 38 different job titles provided by the clients and the job titles were mainly blue collar jobs and jobs in health and personal care. Our results indicate that CHWs reach the most vulnerable population who have limited health access and high unemployment and that CHWs can effectively be used for linkage to low‐income minority population for applied research. Our analyses found that in this low‐income population, being younger, being African American, being unemployed, and not having health insurance are each associated with not getting vaccinated against COVID‐19, and employment is not associated with having health insurance. We have shown that partnership with CHWs to access their clients as research subjects leads to elucidating new information on the population that can be used in addressing public health programming. [ABSTRACT FROM AUTHOR]

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Background: Federally Qualified Health Centers (FQHCs) deliver care to 26 million Americans living in underserved areas, but few offer telemental health (TMH) services. The social missions of FQHCs and publicly funded state medical schools create a compelling argument for the development of TMH partnerships. In this paper, we share our experience and recommendations from launching TMH partnerships between 12 rural FQHCs and 3 state medical schools. Experience: There was consensus that medical school TMH providers should practice as part of the FQHC team to promote integration, enhance quality and safety, and ensure financial sustainability. For TMH providers to practice and bill as FQHC providers, the following issues must be addressed: (1) credentialing and privileging the TMH providers at the FQHC, (2) expanding FQHC Scope of Project to include telepsychiatry, (3) remote access to medical records, (4) insurance credentialing/paneling, billing, and supplemental payments, (5) contracting with the medical school, and (6) indemnity coverage for TMH. Recommendations: We make recommendations to both state medical schools and FQHCs about how to overcome existing barriers to TMH partnerships. We also make recommendations about changes to policy that would mitigate the impact of these barriers. Specifically, we make recommendations to the Centers for Medicare and Medicaid about insurance credentialing, facility fees, eligibility of TMH encounters for supplemental payments, and Medicare eligibility rules for TMH billing by FQHCs. We also make recommendations to the Health Resources and Services Administration about restrictions on adding telepsychiatry to the FQHCs' Scope of Project and the eligibility of TMH providers for indemnity coverage under the Federal Tort Claims Act. [ABSTRACT FROM AUTHOR]

This paper examines the impacts of the affordable care act (ACA)—which substantially increased insurance coverage through regulations, mandates, subsidies, and Medicaid expansions—on behaviors related to future health risks after 3 years. Using data from the Behavioral Risk Factor Surveillance System and an identification strategy that leverages variation in pre-ACA uninsured rates and state Medicaid expansion decisions, we show that the ACA increased preventive care utilization along several dimensions, but increased risky drinking. These results are driven by the private portions of the law, as opposed to the Medicaid expansion. We also conduct subsample analyses by income and age. [ABSTRACT FROM AUTHOR]