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BACKGROUND: By the end of 2022, nearly 20 million workers in the United States have gained paid-sick-leave coverage from mandates that require employers to provide benefits to qualified workers, including paid time off for the use of preventive services. Although the lack of paid-sick-leave coverage may hinder access to preventive care, current evidence is insufficient to draw meaningful conclusions about its relationship to cancer screening. METHODS: We examined the association between paid-sick-leave mandates and screening for breast and colorectal cancers by comparing changes in 12- and 24-month rates of colorectal-cancer screening and mammography between workers residing in metropolitan statistical areas (MSAs) that have been affected by paid-sick-leave mandates (exposed MSAs) and workers residing in unexposed MSAs. The comparisons were conducted with the use of administrative medical-claims data for approximately 2 million private-sector employees from 2012 through 2019. RESULTS: Paid-sick-leave mandates were present in 61 MSAs in our sample. Screening rates were similar in the exposed and unexposed MSAs before mandate adoption. In the adjusted analysis, cancer-screening rates were higher among workers residing in exposed MSAs than among those in unexposed MSAs by 1.31 percentage points (95% confidence interval [CI], 0.28 to 2.34) for 12-month colorectal cancer screening, 1.56 percentage points (95% CI, 0.33 to 2.79) for 24-month colorectal cancer screening, 1.22 percentage points (95% CI, -0.20 to 2.64) for 12-month mammography, and 2.07 percentage points (95% CI, 0.15 to 3.99) for 24-month mammography. CONCLUSIONS: In a sample of private-sector workers in the United States, cancer-screening rates were higher among those residing in MSAs exposed to paid-sick-leave mandates than among those residing in unexposed MSAs. Our results suggest that a lack of paid-sick-leave coverage presents a barrier to cancer screening. (Funded by the National Cancer Institute.).

Introduction: The COVID-19 pandemic accelerated telemedicine adoption, impacting appointment no-show rates. This study examines neurology appointment preferences among individuals with previous no-shows. Methods: We analyzed transitions between in-person and telemedicine modalities at the Tulane Center for Clinical Neurosciences from August 2020 to February 2021 by race, sex, and insurance type. Logistic regression was used to assess which individual characteristics were associated with switching modalities. Results: A total of 118 patients were included. Transitions to telemedicine visits were significantly higher for female (odds ratio [OR] = 1.868, p = 0.051), Medicaid (OR = 0.433, p = 0.035), and Medicare (OR = 0.228, p = 0.001) beneficiaries compared with males and those with private coverage. Telemedicine to in-person transitions were significantly higher for Medicaid compared with private coverage (OR = 8.133, p = 0.018). Discussion: Females are more likely to switch to telemedicine following an in-person no-show, whereas Medicare beneficiaries are less likely. Medicaid beneficiaries are more likely to revert to in-person appointments. Telemedicine may enhance equitable neurological care, particularly because of its high utilization among females. [ABSTRACT FROM AUTHOR]

Introduction: High-need, high-cost patients can over-utilize acute care services, a pattern of behavior associated with many poor outcomes that disproportionately contributes to increased US healthcare cost. Our objective was to reduce healthcare cost and improve outcomes by optimizing the system of care.  We targeted HNHC patients and identified root causes of frequent healthcare utilization.  We developed a cross-continuum intervention process and a succinct tool called a Complex Care Map (CCM)© that addresses fragmentation in the system and links providers to a comprehensive individualized analysis of the patient story and causes for frequent access to health services. Methods: Using a pre/post test design, this quality improvement project focused on determining if the interdisciplinary intervention called CCM© had an impact on healthcare utilization and costs for HNHC patients.  Analysis was conducted between November 2012 and December 2015 at Mercy Health Saint Mary’s, a Midwestern urban hospital with greater than 80,000 annual emergency department visits.  Included patients had three or more hospital visits (ED or IP) in the 12 months prior to initiation of a CCM© (n=339).  Individualized CCMs© were created and made available in the Electronic Medical Record (EMR) to all healthcare providers. We compared utilization, cost, social, and healthcare access variables from the EMR and cost accounting system for 12 months before and after CCMs© implementation.  Both descriptive and limited inferential statistics were utilized. Results: ED mean visits decreased 43% (p

Whether Medicaid can function as a safety net to offset health risks created by health insurance coverage losses due to job loss is conditional on (1) the eligibility guidelines shaping the pathway for households to access the program for temporary relief, and (2) Medicaid reimbursement policies affecting the value of the program for both the newly and previously enrolled. We find states with more expansive eligibility guidelines lowered the healthcare access and health risk of coverage loss associated with rising unemployment during the 2007–2009 Great Recession. Rises in cost‐related barriers to care associated with unemployment were smallest in states with expansive eligibility guidelines and higher Medicaid‐to‐Medicare fee ratios. Similarly, states whose Medicaid programs had expansive eligibility guidelines and higher fees saw the smallest recession‐linked declines in self‐reported good health. Medicaid can work to stabilize access to health care during periods of joblessness. Our findings yield important insights into the alignment of at least two Medicaid policies (i.e., eligibility and payment) shaping Medicaid's viability as a safety net. [ABSTRACT FROM AUTHOR]

We use changes to Medicaid immediate postpartum policy to test whether non‐monetary costs are meaningful obstacles to health care. Medicaid in several states currently covers long‐acting reversible contraceptives (LARCs, including IUDs and implants) immediately following delivery of a child, eliminating much of the time‐cost and stress associated with obtaining a LARC. Postpartum LARCs can reduce unintended and short‐interval pregnancies, which are associated with adverse neonatal outcomes. Births that occur in Catholic‐owned hospitals are an ideal control group, because these hospitals are prohibited from offering family‐planning services, including LARCs. Using difference‐in‐differences and individual‐level administrative data from Louisiana and New York, we find eliminating non‐monetary obstacles increases take‐up of a high‐value and highly effective form of contraception. Additionally, we find no evidence of crowd‐out of outpatient LARCs. [ABSTRACT FROM AUTHOR]

Employer health plan premiums are often subsidized at different levels according to enrollee income. When enrollees cross an income threshold, they lose some of the income-based subsidy resulting in higher premium prices for their plan choices. We use these discontinuous subsidy reductions, which induce relative price changes across plans, to assess the relationship between premium price and plan choice for workers in a large, national firm. We segmented individuals by income into $100 bins surrounding a $40,000 subsidy threshold and $200 bins surrounding a $110,000 subsidy threshold. We plotted these bins to visualize potential discontinuities and then estimated regression models that fit linear trends to the binned data at each subsidy threshold. Higher income workers were more likely to enrol in high deductible health plans (HDHPs) when those plans became relatively cheaper compared to traditional plans (estimate = −0.057, standard error = 0.027; p-value = 0.02). In contrast, lower income workers were less likely to enrol in a HDHP when the relative price fell (estimate = 0.065, standard error = 0.029, p-value = 0.03). Our findings indicate that responses to relative price distortions between insurance plan options differ by income and that benefit design should account for such heterogeneity. [ABSTRACT FROM AUTHOR]

It is often argued that raising cigarette taxes will significantly reduce the consumption of cigarettes. Consider these two quotes from researchers at the Center for Tobacco Control Research and Education [...]

There is a general consensus among policymakers that raising tobacco taxes reduces cigarette consumption. However, evidence that tobacco taxes reduce adult smoking is relatively sparse. In this paper, we extend the literature in two ways: using data from the Current Population Survey Tobacco Use Supplements we focus on recent, large tax changes, which provide the best opportunity to empirically observe a response in cigarette consumption, and employ a novel paired difference-in-differences technique to estimate the association between tax increases and cigarette consumption. Estimates indicate that, for adults, the association between cigarette taxes and either smoking participation or smoking intensity is negative, small and not usually statistically significant. Our evidence suggests that increases in cigarette taxes are associated with small decreases in cigarette consumption and that it will take sizable tax increases, on the order of 100%, to decrease smoking by as much as 5%. (JEL I18, I12), I. INTRODUCTION There is a general consensus among policymakers that raising tobacco taxes reduces cigarette consumption. (1) However, evidence that tobacco taxes reduce adult smoking is relatively sparse (Gallet and [...]

Introduction: The purpose of this study is to determine the association between Medicaid expansion in Louisiana and cancer mortality by race and sex.Methods: Data from the National Vital Statistics System mortality files were used to quantify deaths from cancer between 2010 and 2019 for Louisiana and a sample of states that had yet to adopt the Affordable Care Act's Medicaid expansion as of December 2019. A series of population-weighted comparative interrupted time series models were estimated to determine whether Louisiana's Medicaid expansion was associated with reduced cancer mortality. Analyses were conducted in May 2021-August 2021.Results: Medicaid expansion was associated with an average of 3.3 (95% CI= -6.4, -0.1; p=0.045) fewer quarterly cancer deaths per 100,000 Black female Louisiana residents and an average of 5.8 (95% CI= -10.4, -1.1; p=0.015) fewer quarterly cancer deaths per 100,000 Black male residents. There were no statistically significant changes in cancer mortality for White people in Louisiana associated with Medicaid expansion. Following expansion, the Black-White mortality gap in cancer deaths declined by approximately 57% for female individuals (4.6-2.0) and 49% for male individuals (10.1-5.2).Conclusions: Medicaid expansion in Louisiana was associated with a reduction in cancer mortality for Black female and male adults. Estimates of the association between Medicaid expansion and cancer mortality in Louisiana directly relate to the potential impacts for states that have yet to adopt Medicaid expansion under the Affordable Care Act, which are primarily located in the Southern U.S. [ABSTRACT FROM AUTHOR]

Regional variation in health care utilization has been well‐documented, yet uncertainty persists about whether this variation is primarily the result of supply‐side or demand‐side forces. We provide new evidence on this issue by examining changes in health care use for the near‐elderly as they transition from being uninsured into Medicare. Results support a causal, supply‐side explanation of regional variation. Estimates indicate that gaining Medicare coverage in above‐median spending regions increases the probability of at least one hospital visit by 40% and the probability of having more than five doctor visits by 26% relative to similar individuals in below‐median spending regions. [ABSTRACT FROM AUTHOR]