Short-term and Long-term Racial Disparities in VA and non-VA Hospital Outcomes

This research used VA and Medicare data to examine racial patterns in short- and long-term mortality outcomes for elderly male black and white patients hospitalized for heart attack, stroke, hip fracture, congestive heart failure, gastrointestinal bleeding, and pneumonia from 1998 to 2002. The researchers found that at 30 days after admission for five of the six conditions, racial patterns in mortality outcomes were similar in VA and non-VA settings, with black patients having a survival advantage. Among Medicare patients, relative to the mortality outcomes for whites, mortality outcomes for black patients deteriorated over time until black Medicare patients had worse 2-year mortality for all conditions except congestive heart failure. In contrast, among VA patients, the relative decline in mortality for blacks was less marked and statistically significant only for hip fracture and stroke. These findings suggest that factors unrelated to hospital care play important roles in longer term mortality rates for the examined conditions. The findings also suggest that the integrated health care delivery system of the VA may attenuate racial disparities in health by mitigating the environmental factors that contribute to mortality for up to two years after hospitalization

How the Newly Insured Use Health Services: a Lesson for the U.S. from Medicare

The Congressional Budget Office estimates that about 32 million previously uninsured people will gain coverage by 2016, when health care reforms are fully implemented. But will these newly insured people use the health care system in the same ways as others? Is insurance enough to change patterns of use? The example of Medicare may provide some insight. This Issue Brief summarizes research that investigates how health care use and patterns change among the uninsured and insured once they gain Medicare coverage at age 65

Child Neurology: Workforce and Practice Characteristics

For more than a decade, reports have indicated that the supply of child neurologists is inadequate to provide care for the growing number of children with acquired and genetic neurological conditions. It is critical to understand how the shortages affect the practice of child neurology, the attitudes of child neurologists, and ability of the field to attract new members. This Issue Brief examines these workforce issues, and profiles the attitudes and practice characteristics of child neurologists and trainees

Job Stability in the United States

Two key attributes of a job are its wage and its duration. Much has been made of changes in the wage distribution in the 1980s, but little attention has been given to job durations since Hall (1982). We fill this void by examining the temporal evolution of job retention rates in U.S. labor markets, using data assembled from the sequence of Current Population Survey job tenure supplements. In contrast to the distribution of wages, which clearly changed in the 1980s, we find that job retention rates have remained stable.

The Skinny on Narrow Networks in Health Insurance Marketplace Plans

The Affordable Care Act (ACA) has prompted health plans to increase their use of “narrow networks” of providers as a cost containment strategy. The Leonard Davis Institute of Health Economics (LDI) has assembled the first integrated dataset of physician networks for the plans offered on the ACA marketplace. This data brief uses this new resource to describe the breadth of the physician networks in plans sold on the state and federal marketplaces. The percent of physician networks that were classified as small or x-small came to 41% overall, 55% for HMO networks, and 25% for PPO networks

What Window Shopping the Health Insurance Exchanges in Year Two Revealed about the State of the Consumer Experience

Soon after the launch of HealthCare.gov, the exchange websites that formed the vanguard of the Affordable Care Act quickly became notorious for numerous bugs, crashes, and painfully slow loading times. Over a year later, the portals have reached a sufficient level of stability and core functionality on the back end. But what about the front end?https://repository.upenn.edu/pennwhartonppi/1024/thumbnail.jp

State Variation in Narrow Networks on the ACA Marketplaces

In June, we presented national data from one of the first attempts to measure the size of provider networks in plans sold on the health insurance marketplaces. We used simple “T-shirt” sizes to categorize networks in a way that could help consumers quickly grasp the choices they were making. In this Data Brief, we present network sizes summarized up to the level of the state and the rating area. This analysis should help regulators and consumers assess and understand the trade-off between premiums and network size as we enter the next open enrollment period

The Burden of Health Care Costs for Working Families

Health care spending represents a growing share of our national income, and based on current projections, will increase from 16% of the gross domestic product today to 20% by 2018. What does this mean for typical working families with private health insurance, who shoulder the financial burden of maintaining the current system? In this Issue Brief, Polsky and Grande construct a typical health care budget for working families of various income levels, calculate the percentage of total compensation devoted to health care over time, and project how rising health care costs will affect standards of living in the future. Their findings remind us that what works today also has to work tomorrow. Sustainability depends critically on successful cost containment

Insurance Coverage and Access to Care Under the Affordable Care Act

SUMMARY: This brief details changes in insurance coverage and access to care under the Affordable Care Act. About 20 million individuals gained coverage under the law and access to care improved. Despite these gains, more than 27 million individuals are still uninsured, and many others face barriers in accessing care. As a result of the 2016 elections, the future of the ACA is uncertain. As the next Administration and policymakers debate further health system reforms, they should consider the scope of the ACA’s effects on their constituents

The Magnitude and Nature of Risk Selection in Employer-Sponsored Health Plans

Most existing studies of risk selection in the employer-sponsored health insurance market are case studies of a single employer or of an employer coalition in a single market. We examine risk selection in the employer-sponsored market by applying a switcher' methodology to a national, panel data set of enrollees in employer-sponsored health plans. We find that people who switched from a non-HMO to an HMO plan used 11 percent fewer medical services in the period prior to switching than people who remained in the non-HMO plan, and that this relatively low use persists once they enroll in an HMO. Furthermore, people who switch from an HMO to a non-HMO plan used 18 percent more medical services in the period prior to switching than those who remained in an HMO plan. HMOs would most likely continue to experience favorable risk selection if employers adjusted health plan payments based on enrollees' gender and age because the selection appears to occur based on enrollee characteristics that are difficult to observe such as preferences for medical care and health status.