Health Insurance

Financial and structural characteristics of the public and private programs that cover medical costs. LDI analyzes how to expand and improve coverage through insurance exchanges, employer-sponsored insurance, and public programs.

Medicare SNF Payment Policy: What a Difference a Day Makes

Dec. 19, 2019

It is hardly surprising that there’s a spike in the number of Medicare patients discharged from postacute care in a skilled nursing facility (SNF) the day before their copayment jumps from $0 to more than $150. However, the question remains whether this payment policy – which completely covers the first 20 days of a SNF stay – affects patient outcomes in any way.

Insurance Impacts Survival for Children, Adolescents, and Young Adults with Bone and Soft Tissue Sarcomas

Lena Winestone, MD,MS
Dec. 15, 2019

Neela L. Penumarthy, Robert E. Goldsby, Stephen C. Shiboski, Rosanna Wustrack, Patricia Murphy, Lena E. Winestone

Abstract [from journal]

Background: While racial/ethnic survival disparities have been described in pediatric oncology, the impact of income has not been extensively explored. We analyzed how public insurance influences 5‐year overall survival (OS) in young patients with sarcomas.

Methods: The University of California San Francisco Cancer Registry was used to identify patients aged 0‐39 diagnosed

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Could a Public Health Insurance Option Lead to More Competitive Markets?

Issue Brief
Dec. 10, 2019

Calls for the establishment of a “public option,” which emerged during the debate on the Affordable Care Act, have reemerged in this election season. Some proposals base the public option on Medicare, while others on Medicaid. In this article, Wharton professor and LDI Senior Fellow Mark Pauly discusses the likely effects of a public option on private markets, using experience in Medicare Advantage as a guide. Will the public option become the preferred one, sweeping away the private market? Or can the public and private options peacefully coexist?  

Disease-Specific Plan Switching Between Traditional Medicare and Medicare Advantage

Nov. 22, 2019

Sungchul Park, Paul Fishman, Lindsay White, Eric B Larson, Norma B Coe

Abstract [from journal]

Introduction: Previous research has reported switching from traditional Medicare (TM) to Medicare Advantage (MA) plans increased from 2006 to 2011 at the aggregate level, and switching from MA plans to TM also increased. However, little is known about switching behavior among individuals with specific chronic diseases.

Objective: To examine disease-specific switching patterns between TM and MA to understand the impact on MA

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Physician Consolidation and the Spread of Accountable Care Organizations

Research Brief
Nov. 4, 2019

Accountable Care Organizations (ACOs) are groups of physicians and hospitals that jointly contract to care for a patient population. ACO contracts incentivize coordination of care across providers. This can lead to greater consolidation of physician practices, which can in turn generate higher costs and lower quality. Given this, the study asks, as ACOs enter health care markets, do physician practices grow larger?

Social and Health-Related Factors Associated with Enrollment in Medicare Advantage Plans in Older Adults

Robert Burke, MD, University of Pennsylvania
Oct. 16, 2019

Amit Kumar, Maricruz Rivera‐Hernandez, Amol M. Karmarkar, Lin‐Na Chou, Yong‐Fang Kuo, Julie A. Baldwin, Orestis A. Panagiotou, Robert E. Burke, Kenneth J. Ottenbacher 
 

Abstract [from journal]

Objectives: We assessed the characteristics of older Mexican American enrollees in traditional fee-for-service (FFS) and Medicare Advantage (MA) plans and the factors associated with disenrollment from FFS and enrollment in MA plans.

Design: Longitudinal study linked with Medicare claims data.

Setting: The Hispanic Established Populations for the Epidemiologic Study of the Elderly.

Participants: Community-dwelling Mexican American older adults (N = 1455).

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Health Care Safety-Net Programs After The Affordable Care Act

Issue Brief
Oct. 1, 2019

Prior to the Affordable Care Act (ACA), health care safety-net programs were the primary source of care for over 44 million uninsured people. While the ACA cut the number of uninsured substantially, about 30 million people remain uninsured, and many millions more are vulnerable to out-of-pocket costs beyond their resources. The need for the safety net remains, even as the distribution and types of need have shifted. This brief reviews the effects of the ACA on the funding and operation of safety-net institutions. It highlights the challenges and opportunities that health care reform presents to safety-net programs, and how they have adapted and evolved to continue to serve our most vulnerable residents.

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