Robert Wood Johnson Foundation Health Priorities Survey Report: The Medical System and the Uninsured

Presents results of a survey on the healthcare system, priorities for reform, and views on the uninsured, a public insurance plan, and individual mandates, compared with other surveys. Analyzes how the way reform elements are described affects responses

Would you want to know? Public attitudes on early diagnostic testing for Alzheimer's disease

INTRODUCTION: Research is underway to develop an early medical test for Alzheimer's disease (AD). METHODS: To evaluate potential demand for such a test, we conducted a cross-sectional telephone survey of 2,678 randomly selected adults across the United States and four European countries. RESULTS: Most surveyed adults (67%) reported that they are "somewhat" or "very likely" to get an early medical test if one becomes available in the future. Interest was higher among those worried about developing AD, those with an immediate blood relative with AD, and those who have served as caregivers for AD patients. Older respondents and those living in Spain and Poland also exhibited greater interest in testing. Knowing AD is a fatal condition did not influence demand for testing, except among those with an immediate blood relative with the disease. CONCLUSIONS: Potential demand for early medical testing for AD could be high. A predictive test could not only advance medical research, it could transform political and legal landscapes by creating a large constituency of asymptomatic, diagnosed adults

Employment and Compliance with Pandemic Influenza Mitigation Recommendations

Noncompliance may result from job insecurity and financial problems associated with missing work

A four-country survey of public attitudes towards restricting healthcare costs by limiting the use of high-cost medical interventions

Objective: To discern how the public in four countries, each with unique health systems and cultures, feels about efforts to restrain healthcare costs by limiting the use of high-cost prescription drugs and medical/surgical treatments. Design: Cross-sectional survey. Setting: Adult populations in Germany, Italy, the UK and the USA. Participants: 2517 adults in the four countries. A questionnaire survey conducted by telephone (landline and cell) with randomly selected adults in each of the four countries. Main outcome measures: Support for different rationales for not providing/paying for high-cost prescription drugs/medical or surgical treatments, measured in the aggregate and using four case examples derived from actual decisions. Measures of public attitudes about specific policies involving comparative effectiveness and cost-benefit decision making. Results: The survey finds support among publics in four countries for decisions that limit the use of high-cost prescription drugs/treatments when some other drug/treatment is available that works equally well but costs less. The survey finds little public support, either in individual case examples or when asked in the aggregate, for decisions in which prescription drugs/treatments are denied on the basis of cost or various definitions of benefits. The main results are based on majorities of the public in each country supporting or opposing each measure. Conclusions: The survey findings indicate that the public distinguishes in practice between the concepts of comparative effectiveness and cost-effectiveness analysis. This suggests that public authorities engaged in decision-making activities will find much more public support if they are dealing with the first type of decision than with the second

Both The 'Private Option And Traditional Medicaid Expansions Improved Access To Care For Low-Income Adults

Under the Affordable Care Act, thirty states and the District of Columbia have expanded eligibility for Medicaid, with several states using Medicaid funds to purchase private insurance (the “private option”). Despite vigorous debate over the use of private insurance versus traditional Medicaid to provide coverage to low-income adults, there is little evidence on the relative merits of the two approaches. We compared the first-year impacts of traditional Medicaid expansion in Kentucky, the private option in Arkansas, and nonexpansion in Texas by conducting a telephone survey of two distinct waves of low-income adults (5,665 altogether) in those three states in November–December 2013 and twelve months later. Using a difference-in-differences analysis, we found that the uninsurance rate declined by 14 percentage points in the two expansion states, compared to the nonexpansion state. In the expansion states, again compared to the nonexpansion state, skipping medications because of cost and trouble paying medical bills declined significantly, and the share of individuals with chronic conditions who obtained regular care increased. Other than coverage type and trouble paying medical bills (which decreased more in Kentucky than in Arkansas), there were no significant differences between Kentucky’s traditional Medicaid expansion and Arkansas’s private option, which suggests that both approaches improved access among low-income adults

The Impact of Experience with a Family Member with Alzheimer's Disease on Views about the Disease across Five Countries

The objective of this paper is to understand how the public's beliefs in five countries may change as more families have direct experience with Alzheimer's disease. The data are derived from a questionnaire survey conducted by telephone (landline and cell) with 2678 randomly selected adults in France, Germany, Poland, Spain, and the United States. The paper analyzes the beliefs and anticipated behavior of those in each country who report having had a family member with Alzheimer's disease versus those who do not. In one or more countries, differences were found between the two groups in their concern about getting Alzheimer's disease, knowledge that the disease is fatal, awareness of certain symptoms, and support for increased public spending. The results suggest that as more people have experience with a family member who has Alzheimer's disease, the public will generally become more concerned about Alzheimer's disease and more likely to recognize that Alzheimer's disease is a fatal disease. The findings suggest that other beliefs may only be affected if there are future major educational campaigns about the disease. The publics in individual countries, with differing cultures and health systems, are likely to respond in different ways as more families have experience with Alzheimer's disease

New Approaches In Medicaid: Work Requirements, Health Savings Accounts, And Health Care Access

Alternative approaches in Medicaid are proliferating under the Trump Administration. Using a novel telephone survey, we assessed views on health savings accounts, work requirements, and private vs. public coverage. Our sample included low-income non-elderly adults (N=2739) in three Midwestern states with different policies: 1) Ohio, which expanded traditional Medicaid; 2) Indiana, which expanded using health savings accounts (“POWER” Accounts); and 3) Kansas, which has not expanded. We found that coverage and access to care in 2017 were significantly higher in expansion states than in Kansas. However, compared to Ohio’s traditional expansion, cost-related barriers were more common in Indiana. Among beneficiaries eligible for Indiana’s program, 39% had not heard of POWER Accounts, and only 36% were making their required payments, meaning that nearly two-thirds were potentially subject to loss of benefits or coverage. Meanwhile, in Kansas, 77% supported expanding Medicaid, with similar attitudes towards Medicaid or private insurance. 49% of potential Medicaid enrollees in Kansas were already working, 34% were disabled, and only 11% were unemployed and would seek work if required by Medicaid. These findings suggest that curren

Public Response to Community Mitigation Measures for Pandemic Influenza

Results from a national survey indicated that most persons would follow public health officials’ guidelines

Beyond Health Insurance: Remaining Disparities in U.S. Health Care in the Post-ACA Era

Context: The Affordable Care Act (ACA) has reduced the U.S.’s uninsured rate to an historic low. But coverage is only one of many factors contributing to racial and income-based disparities in health care access, affordability, and quality. Methods: Using a novel 2015 national survey of over 8,000 Americans, we examined disparities between low-income and high-income adults, and between racial/ethnic minorities and whites. We conducted a series of regression analyses, starting with models that only took into account income or race, and then sequentially adjusted for health insurance, state of residence, demographics, and health status. We examined self-reported quality of care, cost-related delays in care, and emergency department (ED) use due to lack of available appointments. Then we used multivariate regression to assess respondents’ views of whether quality and affordability had improved over the past two years and whether the ACA was helping them. Findings: Quality of care ratings were significantly worse among lower-income adults than higher-income adults. Only 10-25% of this gap was explained by health insurance coverage. Cost-related delays in care and ED use due to lack of available appointments were nearly twice as common in the lowest-income group, and less than 40% of these disparities was explained by insurance. There were significant racial/ethnic gaps: reported quality of care was worse among blacks and Latinos than whites, with 16-70% explained by insurance. In contrast to these disparities, lower-income and minority groups were generally more likely than whites or higher-income adults to say that the ACA was helping them and that the quality and/or affordability of care had improved in recent years. Conclusions: Our post-health reform survey shows ongoing stark income and racial disparities in the health care experiences of Americans. While the ACA has narrowed these gaps, insurance expansion alone will not be enough to achieve health care equity