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.

Comparison of Site of Death, Health Care Utilization, and Hospital Expenditures for Patients Dying With Cancer in 7 Developed Countries

Feb. 17, 2016

Justin Bekelman, Scott Halpern, Carl Rudolf Blankart, Julie Bynum, Joachim Cohen, Robert Fowler, Stein Kaasa, Lukas Kwietniewski, Hans Olav Melberg, Bregie Onwuteaka-Philipsen, Mariska Oosterveld-Vulg, Andrew Pring, Joans Schreyogg, Connie Ulrich...

In The Journal of the American Medical Association, Justin Bekelman and colleagues, including Scott Halpern, Connie Ulrich and Ezekiel Emanuel compare site of death, health care utilization and hospital expenditures in 7 countries: Belgium, Canada, England, Germany, the Netherlands, Norway and the United States. Using administrative and registry data, the researchers measured deaths in acute care hospital, along with inpatient and outpatient measures, and hospital expenditures paid by insurers. They find that a smaller proportion of decedents, older than 65, died in acute...

Psoriasis in the US Medicare Population: Prevalence, Treatment, and Factors Associated with Biologic Use

Jan. 29, 2016

Junko Takeshita, Joel Gelfand, Penxiang Li, Lionel Pinto, Xinyan Yu, Preethi Rao, Hema Viswanathan, Jalpa Doshi

In the Journal of Investigative Dermatology, Junko Takeshita and colleagues, including Preethi Rao and Jalpa Doshi, look at factors associated with the use of biologics and other treatments for psoriasis. They  analyzed claims from a nationally representative sample of Medicare beneficiaries with Part D drug coverage. The researchers find that Medicare Part D beneficiaries without a low-income subsidy (LIS) had 70% lower odds of having received biologics than those with LIS. Similarly, the odds of having received biologics were 69% lower among black patients compared with white...

Patient satisfaction and non-UK educated nurses: a cross-sectional observational study of English National Health Service Hospitals

Jan. 29, 2016

Hayley Germack, Peter Griffiths, Douglas Sloane, Anne Marie Rafferty, Jane Ball, Linda Aiken

In BMJ Open, Hayley Germack and colleagues, including Linda Aiken, examine the association between patient satisfaction with nursing care in National Health Service (NHS) hospitals in England and the proportion of non-UK educated nurses providing care. The authors used data from the 2010 NHS Adult Inpatient Survey merged with data from nurse and hospital administrator surveys. They found a significant association between the percentage of non-UK educated nurses providing bedside care and patient satisfaction; hospitals with higher percentages of non-UK educated nurses had lower...

New Year, New Issues

Jan. 27, 2016

It is cold outside, but certain health policy debates are hot enough to thaw even snowy Philadelphia. Puns aside, 2016 looks like it will provide no shortage of interesting health policy developments. Here’s what we expect to be talking about in 2016 on Insurance Reform, one of our key research and policy themes.  

Taking the Training Wheels Off of Health Reform

Jan. 21, 2016

While controversy and rancor are perhaps the only certainties in the ongoing health care reform debate, a majority of Americans agree that expanding health insurance coverage is a worthy societal goal. One of the primary obstacles to achieving this goal is its cost. However, it is another obstacle that may pose the most daunting challenge: making health insurance more affordable for those lacking coverage without harming those with coverage.

ACA-Mandated Elimination of Cost Sharing for Preventive Screening Has Had Limited Early Impact

Research Brief
Dec. 21, 2015

To reduce financial barriers to receiving recommended preventive care, the Affordable Care Act (ACA) eliminated patient cost sharing for many preventive services. This provision, rolled out between September 2010 and January 2011, applies to all private insurance plans and exempts ‘grandfathered plans’. In this study, LDI Senior Fellow Shivan Mehta and colleagues investigated whether this ACA provision has its intended effect on colonoscopy and mammography rates. 

The Institutional Effects of Incarceration: Spillovers From Criminal Justice to Health Care

Dec. 18, 2015

Jason Schnittker, Christopher Uggen, Sarah Shannon, Suzy McElrath

In The Milbank Quarterly, Jason Schnittker and colleagues examine the spillover effects of growth in state-level incarceration rates on the US health care system, prior to the Affordable Care Act. The authors merged cross-sectional individual-level data on health care behavior to aggregate state-level data regarding incarceration, and then analyzed trends over time in health care access and utilization. They find that individuals residing in states with a larger number of former prison inmates have diminished access to care, less access to specialists, less trust in physicians,...

Advancing LGBTQ Health – Hot topics on the national stage

Dec. 9, 2015

Although Section 1557 of the ACA may not be well known to the public, it took center stage at the recent Gay and Lesbian Medical Association (GLMA) annual conference in Portland, Oregon. The conference educates practitioners and students about the unique health needs of lesbian, gay, bisexual, transgender and queer (LBGTQ) individuals and families, and reports on the latest research on LGBTQ health. Here are some of the latest research and policy developments emerging from the conference.

Section 1557 of the ACA

Quality of Health Insurance Coverage and Access to Care for Children in Low-Income Families

Dec. 7, 2015

Amanda Kreider, Benjamin French, Jaya Aysola, Brendan Saloner, Kathleen Noonan, David Rubin

In JAMA Pediatrics, Amanda Kreider and colleagues, including Benjamin French, Jaya Aysola, Brendan Saloner, Kathleen Noonan and David Rubin, compare health care access, quality and cost outcomes by insurance type for children in low or moderate income households. Using family-reported measures from the National Surveys of Children’s Health, the authors examined children’s access to preventive and specialty care and caregiver satisfaction with insurance coverage, and also characterized unmet health needs and out-of-pocket costs over the last decade. The analysis revealed that...

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