Access to Care

The extent to which someone can gain access to the health care system, and the financial, social, and organizational factors that affect a person’s ability to get needed care in a timely way.

Twelve-Month Outcomes After Transplant of Hepatitis C–Infected Kidneys Into Uninfected Recipients: A Single-Group Trial

Peter P. Reese, MD, MSCE
Aug. 13, 2018

Peter P. Reese, Peter L. Abt, Emily A. Blumberg, Vivianna M. Van Deerlin, Roy D. Bloom, Vishnu S. Potluri, Matthew Levine, Paige Porrett, Deirdre Sawinski, Susanna M. Nazarian, Ali Naji, Richard Hasz, Lawrence...

Abstract [from journal]

BackgroundOrgans from hepatitis C virus (HCV)–infected deceased donors are often discarded. Preliminary data from 2 small trials, including THINKER-1 (Transplanting Hepatitis C kidneys Into Negative KidnEy Recipients), suggested that HCV-infected kidneys could be safely transplanted into HCV-negative patients. However, intermediate-term data on quality of life and renal function are needed to counsel patients about risk....

Restricted Provider Choice in the ACA Marketplace

Aug. 8, 2018

On November 1st, the sixth year of open enrollment on the ACA Marketplace will start. While the basic rules that govern the Marketplace and the sliding-scale subsidies remain intact, gains in enrollment are unlikely given the end of penalties for the individual mandate, the emergence of association health plans, and new rules related to “short-term limited duration.”

Learning Your Alzheimer’s Risk: Implications for Long-Term Care Insurance

Jul. 25, 2018

In the not-too-distant future, individuals may be able to learn their risk of developing Alzheimer’s disease through biomarkers – measures of disease activity detected up to 20 years before symptoms present. This information would allow individuals (and their loved ones) to prepare for future cognitive and functional decline, but it also has implications for the purchase of private long-term care insurance.

Modernizing Medicare Funding for Nurse Education

Jun. 21, 2018

With policies rooted in the 1960s, it’s time to change how Medicare pays for nurse education. In a New England Journal of Medicine Perspective, LDI Senior Fellow Linda Aiken and colleagues present a compelling case for funding a new consortium model that trains nurse practitioners (NPs) in the community settings where they are a crucial source of primary care.

Measuring Emergency Care Survival: The Implications of Risk-Adjusting for Race and Poverty

Jun. 20, 2018

Kimon L.H. Ioannides, Avi Baehr, David N. Karp, Douglas J. Wiebe, Brendan G. Carr,...

ABSTRACT [FROM JOURNAL]

Objectives: We determined the impact of including race, ethnicity, and poverty in risk adjustment models for emergency care sensitive conditions mortality that could be used for hospital pay‐for‐performance initiatives. We hypothesized that adjusting for race, ethnicity, and poverty would bolster rankings for hospitals that cared for a disproportionate share of non‐white, Hispanic, or poor patients.

Methods: We performed a cross‐sectional analysis

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What State Legislators Say About Medicaid, and Why It Matters

May. 29, 2018

Medicaid’s federal-state partnership structure has long permitted states to adopt modifications to coverage design, including benefits and cost-sharing. That structure, combined with an Administration signaling its support for greater state flexibility and funding constraints, could produce substantial shifts in state Medicaid policy.

Safeguards Needed in Medicaid Work Requirements

May. 10, 2018

In a push to encourage “personal responsibility,” the Centers for Medicare and Medicaid Services (CMS) has approved work requirements as a condition for receiving Medicaid benefits in four states - Kentucky, Indiana, Arkansas, and most recently New Hampshire, with applications from other states pending.

Being Uninsured in America

Apr. 26, 2018

For the nearly 30 million people in the United States who have no health insurance, gaining access to care and paying for that care can be a challenge.  A new “secret shopper” study explores whether the uninsured can get a new primary care appointment, and at what price.

A Qualitative Exploration of Co-location as an Intervention to Strengthen Home Visiting Implementation in Addressing Maternal Child Health

Feb. 28, 2018

Katherine S. Kellom, Meredith Matone, Aderinola Adejare, Frances K. Barg, David M. Rubin, Peter F. Cronholm

Abstract [from journal]

Objectives: The aim of this paper is to explore the process and impact of co-locating evidence-based maternal and child service models to inform future implementation efforts.

Methods: As part of a state-wide evaluation of maternal and child home visiting programs, we conducted semi-structured interviews with administrators and home visitors from home visiting agencies across Pennsylvania. We collected 33 interviews from 4 co-located agencies. We used the Consolidated Framework for...

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