Browsing by Subject "health insurance"
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Item Adverse Selection in the Children’s Health Insurance Program(Sage, 2015-01) Morrisey, Michael A.; Blackburn, Justin; Becker, David J.; Sen, Bisakha; Kilgore, Meredith L.; Caldwell, Cathy; Menachemi, Nir; Department of Nursing, IU School of NursingThis study investigates whether new enrollees in the Alabama Children’s Health Insurance Program have different claims experience from renewing enrollees who do not have a lapse in coverage and from continuing enrollees. The analysis compared health services utilization in the first month of enrollment for new enrollees (who had not been in the program for at least 12 months) with utilization among continuing enrollees. A second analysis compared first-month utilization of those who renew immediately with those who waited at least 2 months to renew. A 2-part model estimated the probability of usage and then the extent of usage conditional on any utilization. Claims data for 826 866 child-years over the period from 1999 to 2012 were used. New enrollees annually constituted a stable 40% share of participants. Among those enrolled in the program, 13.5% renewed on time and 86.5% of enrollees were late to renew their enrollment. In the multivariate 2-part models, controlling for age, gender, race, income eligibility category, and year, new enrollees had overall first-month claims experience that was nearly $29 less than continuing enrollees. This was driven by lower ambulatory use. Late renewals had overall first-month claims experience that was $10 less than immediate renewals. However, controlling for the presence of chronic health conditions, there was no statistically meaningful difference in the first-month claims experience of late and early renewals. Thus, differences in claims experience between new and continuing enrollees and between early and late renewals are small, with greater spending found among continuing and early renewing participants. Higher claims experience by early renewals is attributable to having chronic health conditions.Item Center for Health Economics Research(Office of the Vice Chancellor for Research, 2012-04-13) Royalty, Anne BeesonThe Center for Health Economics Research (CHER) was established by the IU School of Liberal Arts at IUPUI in response to the pressing need for research on health, health care, and health insurance. The Center brings together researchers across the campus and the state with interests in any area of health and health care which can be informed by economics or with implications for economic outcomes. CHER researchers have a diverse set of interests and expertise, ranging from health insurance and health care cost growth to competition in health care markets to health-related quality of life. The Center also plays a local role in linking IUPUI to the community through shared interests in health care and research partnerships in collaboration with medical, business and government entities. In addition, the CHER is linked to and supportive of the Economics Ph.D. program with a specialization in Health Economics. This poster will present an overview of Center researchers, their research, and the upcoming Midwest Health Economics Conference to be hosted by CHER, the Department of Economics, the School of Liberal Arts, and IUPUI.Item Commercial Insurance Coverage Decline Associated with Affordable Care Act: What's Next?(Ohio Valley Society of Plastic Surgeons, 2017-02-15) Fielding, Stephen M.; Jerkins, David; Johnson, R. MichaelBACKGROUND: A key feature of the Affordable Care Act was the establishment of insurance exchanges and subsidies to assist Americans in obtaining affordable commercial insurance. This study was undertaken to determine whether this effort has met its goal. METHODS: A review of all patients requiring surgery for maxillofacial trauma at a level 1 trauma center was undertaken for time periods before the Affordable Care Act was passed (2008 and 2009), while partially in effect (2012), and after the establishment exchanges and subsidies (2014). Insurance statuses were recorded and rates of commercial insurance coverage during each period were compared. RESULTS: A total of 1,123 patients were included. Of these, 511 were treated before passage of the Affordable Care Act, 288 were treated in 2012, and 324 were treated in 2014. Before passage, 50.5% of patients had commercial insurance. This number was virtually unchanged in 2012. However, after the insurance exchanges and subsidies were established, the percentage of patients with commercial insurance fell to 36.73% (p = 0.004). CONCLUSIONS: Surprisingly, the establishment of insurance exchanges and subsidies through the Affordable Care Act was associated with a decline in rates of commercial insurance coverage. Trends in reimbursement patterns will need to be followed if the law is repealed and replaced.Item Educational Implications of Health Insurance Changes(Elsevier, 2018-02) Shea, Lindsey; Heitkamp, Darel E.; Dunkle, Jeffrey W.; Gunderman, Richard B.; Radiology and Imaging Sciences, School of MedicineItem The Future of the Affordable Care Act: Protecting Economic Health More than Physical Health?(2014) Orentlicher, David; Robert H. McKinley School of LawWhile observers have focused on questions about the extent to which the Affordable Care Act (ACA) will improve access to care, reduce the costs of care, and improve the quality of care, commentary has largely ignored an even more important question — to what extent will ACA improve health? Surprisingly, the link between health care insurance and health is more tenuous than one might think. In the end, the ACA may do more to protect the financial health of poor Americans than to improve their physical health.Item Health insurance status affects hypertension control in a hospital based internal medicine clinic(Elsevier, 2019-05) Oso, Ayodeji A.; Adefurin, Abiodun; Benneman, Monique M.; Oso, Olatunde O.; Taiwo, Muinat A.; Adebiyi, Oluwafisayo O.; Oluwole, Olorunkemi; Medicine, School of MedicineHypertension is a worldwide disorder that contributes significantly to morbidity, mortality, and healthcare costs in both developed and developing communities. A retrospective cohort study of hypertensive patients attending the Internal Medicine continuity clinic at Nashville General Hospital (NGH) between January and December 2007 was conducted. Given the easy access to health care at NGH and affordable Blood pressure (BP) medications, we explored the ability to achieve optimal BP control <140/90 mmHg and evaluated which factors are associated. Of the 199 subjects, 59% achieved BP goal <140/90 mmHg. The mean BP was 139/80 mmHg. Health insurance status was associated with SBP and DBP (All P < 0.046). Patients with health insurance had a 2.2 fold increased odds of achieving BP control compared to patients without health insurance (P = 0.025). Furthermore, the number of BP medications used was significantly associated with SBP and DBP (All P < 0.003). Patients taking more than three BP medications had a 58% reduced odds of achieving optimal BP control compared to patients taking one medication (P = 0.039). Ethnicity was not associated with achieving BP control. Our study revealed the number of BP medications used and health insurance status, are factors associated with achieving BP control.Item The Implications of Insurance Status on Presentation, Surgical Management and Mortality among Non-Metastatic Breast Cancer Patients in Indiana(Elsevier, 2018-12) Obeng-Gyasi, Samilia; Timsina, Lava; Miller, Kathy D.; Ludwig, Kandice K.; Fisher, Carla S.; Haggstrom, David A.; Obstetrics and Gynecology, School of MedicineBackground The National Breast and Cervical Cancer Early Detection Program seeks to reduce health care disparities by providing uninsured and underinsured women access to screening mammograms. The objective of this study is to identify the differences in presentation, surgical management, and mortality among nonmetastatic uninsured patients diagnosed through Indiana's Breast and Cervical Cancer Program compared with patients with private and government (Medicare or Medicaid) insurance. Methods Study data were obtained using the Indiana state cancer registry and Indiana's Breast and Cervical Cancer Program. Women aged 50 to 64 with an index diagnosis of stage 0 to III breast cancer from January 1, 2006 to December 31, 2013, were included in the study. Bivariate intergroup analysis was conducted. Kaplan-Meier estimates between insurance types were compared using the log rank test. All-cause mortality was evaluated using a mixed effects model. Results The groups differed significantly for sociodemographic and clinical variables. Uninsured Indiana Breast and Cervical Cancer Program patients presented with later disease stage (P < .001) and had the highest overall mortality (hazard ratio 2.2, P = .003). Surgical management only differed among stage III patients (P = .012). Conclusion To improve insurance-based disparities in Indiana, implementation of the Breast and Cervical Cancer Program in conjunction with expansion of insurance coverage to vulnerable low-income populations need to be optimized.Item An Insurance Structure to Encourage Investment in Preventive Health Care(2013) Georgakopoulos, NicholasThe incentives for investments in Americans' health are poorly aligned. Health insurers are not sufficiently motivated to invest for the long term. The structure of health insurance does not compensate insurers for investments in lasting health, such as measures preventing chronic disease. If an American changes insurers, the new insurer reaps the benefits of the good health the prior insurer's investment produced. This Essay explores insurers' incentives to invest in health, illustrates how those incentives fail, explores possible improvements, and shows that subsequent insurers should have an obligation to compensate the prior insurer for the averted expenses of expected diseases that did not emerge. This gives insurers the full incentive to prevent chronic disease while strengthening the incentives to develop cures.Item Using Simulation to Assess the Influence of Race and Insurer on Shared Decision-making in Periviable Counseling(Lippincott Williams & Wilkins, 2014-12) Edmonds, Brownsyne Tucker; McKenzie, Fatima; Fadel, William F.; Matthias, Marianne S.; Salyers, Michelle P.; Barnato, Amber E.; Frankel, Richard M.; Department of Obstetrics and Gynecology, IU School of MedicineIntroduction: Sociodemographic differences have been observed in the treatment of extremely premature (periviable) neonates, but the source of this variation is not well understood. We assessed the feasibility of using simulation to test the effect of maternal race and insurance status on shared decision making (SDM) in periviable counseling. Methods: We conducted a 2 × 2 factorial simulation experiment in which obstetricians and neonatologists counseled 2 consecutive standardized patients diagnosed with ruptured membranes at 23 weeks, counterbalancing race (black/white) and insurance status using random permutation. We assessed verisimilitude of the simulation in semistructured debriefing interviews. We coded physician communication related to resuscitation, mode of delivery, and steroid decisions using a 9-point SDM coding framework and then compared communication scores by standardized patient race and insurer using analysis of variance. Results: Sixteen obstetricians and 15 neonatologists participated; 71% were women, 84% were married, and 75% were parents; 91% of the physicians rated the simulation as highly realistic. Overall, SDM scores were relatively high, with means ranging from 6.4 to 7.9 (of 9). There was a statistically significant interaction between race and insurer for SDM related to steroid use and mode of delivery (P < 0.01 and P = 0.01, respectively). Between-group comparison revealed nonsignificant differences (P = <0.10) between the SDM scores for privately insured black patients versus privately insured white patients, Medicaid-insured white patients versus Medicaid-insured black patients, and privately insured black patients versus Medicaid-insured black patients. Conclusions: This study confirms that simulation is a feasible method for studying sociodemographic effects on periviable counseling. Shared decision making may occur differentially based on patients’ sociodemographic characteristics and deserves further study.