IU Indianapolis ScholarWorks :: Browsing by Author "Simon, Kosali"

Browsing by Author "Simon, Kosali"

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Access to Health Insurance and the Use of Inpatient Medical Care: Evidence from the Affordable Care Act Young Adult Mandate
(Elsevier, 2015-01) Antwi, Yaa Akosa; Moriya, Asako S.; Simon, Kosali; Department of Economics, School of Liberal Arts
The Affordable Care Act of 2010 expanded coverage to young adults by allowing them to remain on their parent's private health insurance until they turn 26 years old. While there is evidence on insurance effects, we know very little about use of general or specific forms of medical care. We study the implications of the expansion on inpatient hospitalizations. Given the prevalence of mental health needs for young adults, we also specifically study mental health related inpatient care. We find evidence that compared to those aged 27–29 years, treated young adults aged 19–25 years increased their inpatient visits by 3.5 percent while mental illness visits increased 9.0 percent. The prevalence of uninsurance among hospitalized young adults decreased by 12.5 percent; however, it does not appear that the intensity of inpatient treatment changed despite the change in reimbursement composition of patients.
Characterizing variability in state-level regulations governing opioid treatment programs
(Journal of Substance Abuse Treatment, 2020-04-24) Jackson, Joanna R.; Harle, Christopher A.; Silverman, Ross D.; Simon, Kosali; Menachemi, Nir
Abstract Introduction: The opioid use crisis has left nearly 1 million people in need of treatment. States have focused primarily on policies aimed at decreasing the prevalence of opioid use disorder. However, opioid treatment programs (OTPs), an evidence-based modality which can prevent and decrease opioid-related mortality and morbidity, remain highly complex with variation in treatment by state. A focus on evidence-based state-level regulation of OTPs may help improve the unmet need for treatment. This study characterized the variability in state laws that regulate OTPs and examines how this variability is associated with state characteristics. These data provides an opportunity for policymakers to consider regulations that increase access to care and retention in OTPs, which could improve population health. Materials and Methods: Utilizing legal mapping techniques, we identified all regulations governing OTPs in effect on January 1, 2017 and determined whether the most common regulations were consistent with best practices. We then examined how the number and type of regulations were associated with state characteristics. All legal mapping research was conducted between November 2017 and March 2019. Results: We identified 89 different regulations, the most common of which exists in fewer than half of all states; and most exist in less than 25% of states. Eighteen of the 30 most common regulations were inconsistent with best practice recommendations. Overall, variability in the number and type of OTP regulations was related to geographic location as opposed to state size or political leanings. Conclusions: Wide-ranging variability in the regulations of OTPs exists across the U.S. The majority of state OTP regulations are not congruent with best practices.
Coverage Effects of the ACA's Medicaid Expansion on Adult Reproductive-Aged Women, Postpartum Mothers, and Mothers with Older Children
(Springer, 2022) Bullinger, Lindsey Rose; Simon, Kosali; Edmonds, Brownsyne Tucker; Obstetrics and Gynecology, School of Medicine
Objectives: We estimate the effect of the Affordable Care Act's (ACA) Medicaid expansions on Medicaid coverage of reproductive-aged women at varying childbearing stages. Methods: Using data from the American Community Survey (ACS) (n = 1,977,098) and a difference-in-differences approach, we compare Medicaid coverage among low-income adult women without children, postpartum mothers, and mothers of children older than one year in expansion states to non-expansion states, before and after the expansions. Results: The ACA's Medicaid expansion increased Medicaid coverage among adult women with incomes between 101 and 200% of the federal poverty line (FPL) without children by 10.7 percentage points (54 percent, p < 0.01). Coverage of mothers with children older than one year increased by 9.5 percentage points (34 percent, p < 0.01). Coverage of mothers with infants rose by 7.9 percentage points (21 percent, p < 0.01). Conclusions for practice: Within the population of adult reproductive-aged women, we find a "fanning out" of effects from the ACA's Medicaid expansions. Childless women experience the largest gains in coverage while mothers of infants experience the smallest gains; mothers of children greater than one year old fall in the middle. These results are consistent with ACA gains being the smallest among the groups least targeted by the ACA, but also show substantial gains (one fifth) even among postpartum mothers.
Effects of Federal Policy to Insure Young Adults: Evidence from the 2010 Affordable Care Act's Dependent-Coverage Mandate
(2013) Akosa Antwi, Yaa; Moriya, Asako S.; Simon, Kosali
Using data from the Survey of Income and Program Participation (SIPP), we study the health insurance and labor market implications of the recent Affordable Care Act (ACA) provision that allows dependents to remain on parental policies until age 26. Our comparison of outcomes for young adults aged 19-25 with those who are older and younger, before and after the law, shows a high take-up of parental coverage, resulting in substantial reductions in uninsurance and other forms of coverage. We also find preliminary evidence of increased labor market flexibility in the form of reduced work hours.
Effects of social distancing policy on labor market outcomes
(Wiley, 2023) Gupta, Sumedha; Montenovo, Laura; Nguyen, Thuy; Lozano-Rojas, Felipe; Schmutte, Ian; Simon, Kosali; Weinberg, Bruce A.; Wing, Coady; Economics, School of Liberal Arts
US workers receive unemployment benefits if they lose their job, but not for reduced working hours. In alignment with the benefits incentives, we find that the labor market responded to COVID-19 and related closure-policies mostly on the extensive (12 pp outright job loss) margin. Exploiting timing variation in state closure-policies, difference-in-differences (DiD) estimates show, between March 12 and April 12, 2020, employment rate fell by 1.7 pp for every 10 extra days of state stay-at-home orders (SAH), with little effect on hours worked/earnings among those employed. Forty percentage of the unemployment was due to a nationwide shock, rest due to social-distancing policies, particularly among "non-essential" workers.
Essays in health economics
(2018-06-22) Ghosh, Ausmita; Royalty, Anne Beeson; Simon, Kosali; Freedman, Seth; Morrison, Wendy; Antwi, Yaa Akosa
My dissertation is a collection of three essays on the design of public health insurance in the United States. Each essay examines the responsiveness of health behavior and healthcare utilization to insurance-related incentives and draws implications for health policy in addressing the needs of disadvantaged populations. The first two essays evaluate the impact of Medicaid expansions under the Affordable Care Act (ACA) on health and healthcare utilization. The Medicaid expansions that included full coverage of preconception care, led to a decline in childbirths, particularly those that are unintended. In addition, these fertility reductions are attributable to higher utilization of Medicaidfinanced prescription contraceptives. The second essay documents patterns of aggregate prescription drug utilization in response to the Medicaid expansions. Within the first 15 months following the policy change, Medicaid prescriptions increased, with relatively larger increases for chronic drugs such as diabetes and cardio-vascular medications, suggesting improvements in access to medical care. There is no evidence of reductions in uninsured or privately-insured prescriptions, suggesting that Medicaid did not simply substitute for other forms of payment, and that net utilization increased. The effects on utilization are relatively higher in areas with larger minority and disadvantaged populations, suggesting reduction in disparities in access to care. Finally, the third essay considers the effect of Medicaid coverage loss on hospitalizations and uncompensated care use among non-elderly adults. The results show that coverage loss led to higher uninsured hospitalizations, suggesting higher uncompensated care use. Most of the increase in uninsured hospitalizations are driven by visits originating in the ED - a pattern consistent with losing access to regular place of care. These results indicate that policies that reduce Medicaid funding could be particularly harmful for patients with chronic conditions.
Examining the Variability in and Impact of State-Level Regulations of Opioid Treatment Programs
(2019-09) Jackson, Joanna Rachel; Menachemi, Nir; Harle, Christopher; Silverman, Ross; Simon, Kosali
The United States is experiencing a severe opioid use epidemic with more than 2 million people currently suffering from opioid use disorder (OUD), of which, over 1 million need treatment. Opioid treatment programs (OTPs) are evidence-based modality providing comprehensive care to individuals experiencing OUD. OTPs provide counseling, medical assessments, and medication-assisted treatment, which decrease the use of illicit opioids, reduce associated deaths, criminality, and improve the psychosocial wellbeing of its patients. However, OTPs have been extensively regulated at the federal, state, and local levels with little consistency and varying degrees of enforcement across the country, particularly at the state level, creating a “regulatory fog”. This complex regulatory environment has made it challenging to study new or changing regulations and their impact on health outcomes. In order to better understand the variation of OTP regulation, this dissertation: (1) employs public health law research methods to map the entire landscape of state-level regulation of OTPs and associated state characteristics in effect on January 1, 2017; (2) examine how state-level regulations affect the delivery of care from the perspective of OTP administrators through key-information interviews; and (3) examines associations between regulatory burden and related health outcomes of individuals experiencing OUD, by state.
Health systems’ use of enterprise health information exchange vs single electronic health record vendor environments and unplanned readmissions
(Oxford University Press, 2019-10-01) Vest, Joshua R.; Unruh, Mark Aaron; Freedman, Seth; Simon, Kosali; Health Policy and Management, School of Public Health
Objective: Enterprise health information exchange (HIE) and a single electronic health record (EHR) vendor solution are 2 information exchange approaches to improve performance and increase the quality of care. This study sought to determine the association between adoption of enterprise HIE vs a single vendor environment and changes in unplanned readmissions. Materials and methods: The association between unplanned 30-day readmissions among adult patients and adoption of enterprise HIE or a single vendor environment was measured in a panel of 211 system-member hospitals from 2010 through 2014 using fixed-effects regression models. Sample hospitals were members of health systems in 7 states. Enterprise HIE was defined as self-reported ability to exchange information with other members of the same health system who used different EHR vendors. A single EHR vendor environment reported exchanging information with other health system members, but all using the same EHR vendor. Results: Enterprise HIE adoption was more common among the study sample than EHR (75% vs 24%). However, adoption of a single EHR vendor environment was associated with a 0.8% reduction in the probability of a readmission within 30 days of discharge. The estimated impact of adopting an enterprise HIE strategy on readmissions was smaller and not statically significant. Conclusion: Reductions in the probability of an unplanned readmission after a hospital adopts a single vendor environment suggests that HIE technologies can better support the aim of higher quality care. Additionally, health systems may benefit more from a single vendor environment approach than attempting to foster exchange across multiple EHR vendors.
Hospitals’ adoption of intra-system information exchange is negatively associated with inter-system information exchange
(Oxford Academic, 2018-09) Vest, Joshua R.; Simon, Kosali; Health Policy and Management, School of Public Health
Introduction U.S. policy on interoperable HIT has focused on increasing inter-system (ie, between different organizations) health information exchange. However, interoperable HIT also supports the movement of information within the same organization (ie, intra-system exchange). Methods We examined the relationship between hospitals’ intra- and inter-system information exchange capabilities among health system hospitals included in the 2010-2014 American Hospital Association’s Annual Health Information Technology Survey. We described the factors associated with hospitals that adopted more intra-system than inter-system exchange capability, and explored the extent of new capability adoption among hospitals that reported neither intra- or inter-system information capabilities at baseline. Results The prevalence of exchange increased over time, but the adoption of inter-system information exchange was slower; when hospitals adopt information exchange, adoption of intra-system exchange was more common. On average during our study period, hospitals could share 4.6 types of information by intra-system exchange, but only 2.7 types of information by inter-system exchange. Controlling for other factors, hospitals exchanged more types of information in an intra-system manner than inter-system when the number of different inpatient EHR vendors in use in health system is larger. Conclusion Consistent with the U.S. goals for more widely accessible patient information, hospitals’ ability to share information has increased over time. However, hospitals are prioritizing within-organizational information exchange over exchange between different organizations. If increasing inter-system exchanges is a desired goal, current market incentives and government policies may be insufficient to overcome hospitals’ motivations for pursuing an intra-system-information-exchange-first strategy.
Medicaid Administrative Costs: Trends, Expansion Effects, and Express Lane Eligibility
(2020-07) Balio, Casey Patricia; Menachemi, Nir; Blackburn, Justin; Yeager, Valerie A.; Simon, Kosali
Medicaid covers 21% of Americans which includes over 65 million children and adults, making it the largest single source of health insurance for Americans. As a public program jointly administered between the federal and state governments, states exhibit substantial control over the structure of their programs, with the intention of modifying programs to fit the needs of the state and population. Medicaid has experienced numerous changes at both the state and federal levels in recent years which have created novel ways of modifying their structures, many of which may have implications for administrative expenditures. As publicly funded programs and given the state autonomy over such, it is important to consider the relationships and effects of such decisions on the performance of these programs. The purpose of this dissertation is to consider numerous variations in state Medicaid programs and the state contexts in which they operate, and the relationship to administrative spending. This dissertation focuses on three studies including 1) a panel analysis of the trends and correlates of state Medicaid administrative expenditures, 2) a quasi-experimental study of the effects of Medicaid expansion on administrative expenditures, and finally 3) a quasi-experimental study of the effects of the use of Express Lane Eligibility on administrative expenditures. Overall, this dissertation provides a better understanding of the variations, correlates, and drivers of Medicaid administrative expenditures.

Browsing by Author "Simon, Kosali"

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