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.

For Third Enrollment Period, Marketplaces Expand Decision Support Tools to Assist Consumers

Research Brief
Apr. 4, 2016

In Health Affairs, Charlene Wong and colleagues go shopping on the most recent iteration of ACA marketplaces. They find added features to help consumers browse and pick a health plan, including total cost estimators and provider look-up tools. Marketplaces differ in how they estimate out-of-pocket costs and how they display plan choices, although most continue to present plans in premium order.

High Cost Sharing and Specialty Drug Initiation Under Medicare Part D: A Case Study in Patients With Newly Diagnosed Chronic Myeloid Leukemia

Research Brief
Apr. 1, 2016

Does high cost sharing in Medicare Part D drug plans affect whether and how quickly patients initiate a recommended and life-extending drug treatment? In American Journal of Managed Care, LDI Senior Fellows Jalpa Doshi, Pengxiang Li and colleagues assess whether Medicare patients newly diagnosed with chronic myeloid leukemia (CML) and subject to significant coinsurance, take longer to initiate tyrosine kinase inhibitors (TKI) treatment than low-income (subsidized) Medicare patients subject to a nominal copayment. 

Biologic therapy adherence, discontinuation, switching, and restarting among patients with psoriasis in the US Medicare population

Mar. 22, 2016

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

In the Journal of the American Academy of Dermatology, Jalpa Doshi and colleagues, including Penxiang Li and Preethi Rao, investigate real-world utilization patterns of biologic therapy in Medicare beneficiaries with psoriasis. Studies indicate low adherence to biologics among patients with psoriasis, yet little is known about the adherence level in the Medicare population. Using data from the Medicare Chronic Condition Data Warehouse Part A, B, and D files with 12-month follow-up after index prescription, Doshi and colleagues conducted a retrospective claims analysis on 2707...

Nurse staffing and the work environment linked to readmissions among older adults following elective total hip and knee replacement

Mar. 14, 2016

Karen Lasater, Matthew McHugh

In the International Journal for Quality in Health Care, Karen Lasater and Matthew McHugh examine the effect of nurse staffing and the work environment on 10- and 30-day unplanned readmissions for Medicare patients following elective total hip and knee replacement. The authors conducted a cross-sectional secondary data analysis using patient administrative data, nurse survey data, and hospital organizational data from acute care hospitals in California, Florida, New Jersey and Pennsylvania. Nurse survey responses were aggregated to construct hospital measures of nurse staffing and...

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.  

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